11 votes

The UK has one of the most equitable health care systems in the world. Here’s how.

Posted by skybrian
Tags: healthcare, united kingdom, nhs, economics, equity, health.public, author.ezra klein, source.vox
https://www.vox.com/platform/amp/2020/1/28/21074386/health-care-rationing-britain-nhs-nice-medicare-for-all

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Title
In the UK's health system, rationing isn't a dirty word
Published
Jan 28 2020
Word count
2974 words

6 comments

  1. Kuromantis
    Link
    Mildly offtopic but this is a really underrated point, especially if you live in a country where corruption is, rather than well-documented and formal like in the US is informal and practically...

    This illustrates a crucial principle for health reform: A public health system is only as good as the government that creates, runs, and protects it. Saying no to treatments that people want to get, and that powerful corporations want to release into the market, will generate furious backlash. If the government isn’t trusted enough to win those fights, or if the politicians turn on the civil servants when they pick those fights, the structure collapses.

    The late Uwe Reinhardt, the famed health economist who helped set up Taiwan’s single-payer system (read my colleague Dylan Scott for more on that), once told me that he feared American politics was too captured to properly construct a single-payer system.

    “I have not advocated the single-payer model here,” he said, “because our government is too corrupt. Medicare is a large insurance company whose board of directors — Ways and Means and Senate Finance — accept payments from vendors to the company. In the private market, that would get you into trouble.

    “When you go to Taiwan or Canada,” he continued, “the kind of lobbying we have [in America] is illegal there. You can’t pay money to influence the party the same way. Therefore, the bureaucrats who run these systems are pretty much insulated from these pressures.”

    Mildly offtopic but this is a really underrated point, especially if you live in a country where corruption is, rather than well-documented and formal like in the US is informal and practically hidden from the public. One of the problems of social democracy is that it requires the government collecting those greatly expanded taxes to actually receive them and use them for the public benefit as intended. Unfortunately in many places, even these requirements aren't met and so increasing taxes in a country like Brazil wouldn't really help us since there is a high chance the extra money will be laundered by politicians and wasted. Fortunately for the US it has lobbying, which is effectively transparent corruption, meaning all that is needed is to abolish lobbying is to remove superPACs and their ability to lobby and, unlike many other places, actually has candidates actively proposing this because the US population can fund a grassroots campaign.

    5 votes
  2. [3]
    skybrian
    Link
    From the article: [...] [...] [...]

    From the article:

    The paradox of the American health system, then, is that it poses as a system with no limits — there is no centralized authority rationing care or negotiating treatments — even as it turns tens of millions of people away from services they need.

    [...]

    NICE has forced the NHS to become the anti-US: Rather than obscuring its judgments and saying no through countless individual acts of price discrimination, NICE makes the system’s values visible, and it says no, or yes, all at once, in full view of the public.

    [...]

    What sets NICE apart is that it makes its judgments explicit. The organization uses a measure called quality-adjusted life years, or QALYs, to make its recommendations. One year in excellent health equals one QALY. As health declines, so does the QALY measurement.

    [...]

    With some exceptions, the organization values one QALY at between 20,000 and 30,000 pounds, roughly $26,000 to $40,000. If a treatment will give someone another year of life in good health and it costs less than 20,000 pounds, it clears NICE’s bar. Between 20,000 and 30,000 pounds, it’s a closer call. Above 30,000 pounds, treatments are often rejected — though there are exceptions, as in some end-of-life care and, more recently, some pricey cancer drugs.

    4 votes
    1. [2]
      json
      Link Parent
      Your snippets missed out defining NICE. I'm not really sure if you're trying to imply anything by pulling out snippets though.

      Your snippets missed out defining NICE.

      In 1999, the British government set up the National Institute for Care Excellence, or NICE, to assess the cost-effectiveness of medications, procedures, and other treatments, and make recommendations to the National Health Service about what to cover and how.

      I'm not really sure if you're trying to imply anything by pulling out snippets though.

      2 votes
      1. skybrian
        Link Parent
        Nothing in particular intended; I just try to quote some key points I thought were interesting. (And in this case, I stopped early since I had to do something.)

        Nothing in particular intended; I just try to quote some key points I thought were interesting. (And in this case, I stopped early since I had to do something.)

        2 votes
  4. DanBC
    Link
    The article mentions the Cancer Drugs Fund as an example of where NICE got things wrong and was over-ruled. Evaluation of the CDF showed most patients got no meaningful benefit from these very...

    The article mentions the Cancer Drugs Fund as an example of where NICE got things wrong and was over-ruled.

    Evaluation of the CDF showed most patients got no meaningful benefit from these very expensive meds and many of them were caused harm. https://www.bmj.com/content/357/bmj.j2097

    That feels to me like NICE getting it right, but being over-ruled by politicians (Lansley in particular is a fucking idiot) who implemented a system that only proved how needed NICE is.

    3 votes