# What do you think about your country's health services?



## Rob è qui

Hi everyone, I hope this topic will not closed, I try to open a discussion that widely interest everyone... I hope this matter is in your forum rules...

What you think about health services in your country? Are they well-organised, can they support you when you need help? have you had bad health services in hospitals or in private clinics? 

What's the situation in your country?

Thanks in advance


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## TRG

I too hope we can have this discussion. In the US, we do not have public financing of health care services except for Medicare and Medicaid. Most people are expected to purchase private health insurance or otherwise pay for their own health care expenses. However, there are many people who do not have insurance either because they can't afford it or don't think they need it. Due to the number of uninsured and the rapidly rising cost of health care, we are having a big debate about public financing of health insurance so that everyone will have access to health care. The arguments in favor of this are fairly straightforward, so I won't go into them. The main argument against is that it is going to lower the quality of health care and limit access to health care. We hear lots of anecdotes in the US from opponents of public health care to the effect the people in countries that have it have to wait for care, can't get the drugs they need, etc. I'd be interesting in hearing a bit more form people in countries with public health care about how they like it or don't as the case may be.


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## Hockey13

I am a part of the group that some might call the "haves" in comparison to the "have-nots." My father makes an enormous amount of money, and for that reason, I have to pay less for my eye-glasses than others who do not have my healthcare program. I can go to the hospital whenever I want, I only encounter problems at bad hospitals.

As an injury-prone hockey player and snowboarder, I have more than used up what he pays them, so it's been very worth-it to us. I once had a surgery for a life-threatening injury that cost something like $20,000 or more. The care I got was fantastic. The doctor I had was top notch and worth every penny. This same doctor spent a few years in South America performing daily surgeries for free on people who had facial clefts. He is tremendously good at what he does and he is tremendously rich for it.

Now I am, for all intents and purposes, an economist. Furthermore I'm a rich economist, but I haven't always been those things. I remember when I was little and didn't have all the advantages I have now, and I know that it is not my hard work that got them to me.

So I have to ask myself, if the main argument against a socialist or partially socialist system is that it will stifle the incentive to work, how does that apply to me? I, and many other lower-upper-class children, have received the fruits of the labor of others. So when it comes to dependents, I think the capitalist "earn it" argument falls flat. I know people who would choose to live in a society where your personal prosperity and that of those around you depends entirely on the prosperity of one person (the patriarch or matriarch of a family), but I don't want to live in that society.

I have taken high-level economics courses and I still feel that though there is some truth to the concept of a Laffer curve, people are not going to stop being productive just because they make $25mil and 50% of it gets taken away. At the end of the day, they're still making $12.5mil and a large portion of the rest would go to public healthcare so that other children might receive the healthcare benefits I've received despite the luck they may or may not have been granted at birth.

I mean, this argument can go on and on, but in the end, you just have to draw a line in the sand and say, "On that side is a society that is cold and does not care about its least wealthy civilians, but if you count the whole wealth, they are richer. On that side is a society that provides services for the lowest of the low and is, on the whole, poorer. Which side do you want to be on?" I choose the latter, as do many in the United States these days, as can be somewhat seen in the as yet feeble attempts to get healthcare legislation passed.


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## Thomsen

I just thought I would add that there is a huge problem hospitals in the USA have.  Poor people without medical insurance can't afford to see a doctor, so they wait until they have life-threatening conditions, go to the hospital and skip out on the bill.  Some hospitals go backrupt and others are understaffed as a result.  At the very least, some sort of national plan to provide preventive care would go a long way toward alleviating that.


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## TRG

Hockey13 said:


> I am a part of the group that some might call the "haves" in comparison to the "have-nots." My father makes an enormous amount of money, and for that reason, I have to pay less for my eye-glasses than others who do not have my healthcare program. I can go to the hospital whenever I want, I only encounter problems at bad hospitals.
> 
> As an injury-prone hockey player and snowboarder, I have more than used up what he pays them, so it's been very worth-it to us. I once had a surgery for a life-threatening injury that cost something like $20,000 or more. The care I got was fantastic. The doctor I had was top notch and worth every penny. This same doctor spent a few years in South America performing daily surgeries for free on people who had facial clefts. He is tremendously good at what he does and he is tremendously rich for it.
> 
> Now I am, for all intents and purposes, an economist. Furthermore I'm a rich economist, but I haven't always been those things. I remember when I was little and didn't have all the advantages I have now, and I know that it is not my hard work that got them to me.
> 
> So I have to ask myself, if the main argument against a socialist or partially socialist system is that it will stifle the incentive to work, how does that apply to me? I, and many other lower-upper-class children, have received the fruits of the labor of others. So when it comes to dependents, I think the capitalist "earn it" argument falls flat. I know people who would choose to live in a society where your personal prosperity and that of those around you depends entirely on the prosperity of one person (the patriarch or matriarch of a family), but I don't want to live in that society.
> 
> I have taken high-level economics courses and I still feel that though there is some truth to the concept of a Laffer curve, people are not going to stop being productive just because they make $25mil and 50% of it gets taken away. At the end of the day, they're still making $12.5mil and a large portion of the rest would go to public healthcare so that other children might receive the healthcare benefits I've received despite the luck they may or may not have been granted at birth.
> 
> I mean, this argument can go on and on, but in the end, you just have to draw a line in the sand and say, "On that side is a society that is cold and does not care about its least wealthy civilians, but if you count the whole wealth, they are richer. On that side is a society that provides services for the lowest of the low and is, on the whole, poorer. Which side do you want to be on?" I choose the latter, as do many in the United States these days, as can be somewhat seen in the as yet feeble attempts to get healthcare legislation passed.


 
You have to remember that we got where we are over a long period of time and we got here incrementally. In order to unwind our present system, if that is what we want, it is probably going to be a long drawn out and incremetal process also. There was a time when the imployer provided health care insurance system that we now have probably looked pretty good. I think unions certainly liked it because it was a way to offer their members something new. At one time, it was not a problem for employers, but lately, the costs are getting out of control so less employers are making it available at little or no cost to the employee. One of the questions we need to answer in the US is, "how much health care can we afford?"


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## emilymonster

Don't even get me started. It was said that by creating a National Health Service, the price of health care in England would reduce, however all the government has managed to do is increase the taxes we pay for health dramatically. Not only is our health care poor but the overworked and underpayed nurses and doctors are no longer respected.
I feel that our health are system is one of the disadvantages of living here and try to avoid using itt as much as I can.


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## palomnik

The health care system as it exists in the USA is either excellent or abysmal, depending on what aspect of it that you're talking about. It's often said that the USA couldn't have socialized medicine because Americans "demand the best care", and that won't be possible if the care is socialized. I don't recall ever making any such demand, and I'm not acquainted with any people who have.

Anyway, as somebody who spent six years working as a consumer advocate on health insurance, one of the most screwed up parts of the system here in the USA is the problem with maintaining health insurance. Currently in the USA, if you have insurance, and then lose it (say, because you've lost your job, and your health benefits with it) and go without coverage for more than 63 days, even when you do get insurance again your new insurance won't have to cover you for any conditions that you had prior to the commencement of your new coverage for at least 6 months...and maybe forever, depending on the type of coverage you have. While this may not be a concern for some people, it is a very serious concern if you have a chronic disease.

The potential to lose health coverage is making people stay employed with their current employer, even when they don't like their job or the line of work that they're in. This state of affairs is, in the final analysis, a result of increasing health care costs and the resultant attempts by insurance companies to keep their claims costs down.


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## Hockey13

emilymonster said:


> Don't even get me started. It was said that by creating a National Health Service, the price of health care in England would reduce, however all the government has managed to do is increase the taxes we pay for health dramatically. Not only is our health care poor but the overworked and underpayed nurses and doctors are no longer respected.
> I feel that our health are system is one of the disadvantages of living here and try to avoid using itt as much as I can.


 
In some countries in Northern Europe, however, the system is not as strained as it is in England. Perhaps this is just a single case.


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## winklepicker

Hockey13 said:


> I am a part of the group that some might call the "haves" in comparison to the "have-nots" ... feeble attempts to get healthcare legislation passed.


 
Thank you, Hockey, for that thoughtful and compassionate post.



emilymonster said:


> Not only is our health care poor but the overworked and underpaid nurses and doctors are no longer respected.


 
I think this is relative. By comparison with the healthcare experienced by almost everyone living outside the West, we are fortunate indeed. 

But as someone famously said, the UK's health service is the second-biggest employer in Europe after the Red Army - and for my money, big organisations don't work.

So I would suggest that the problem is a management one: the people are great, but the system is crazy.


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## Victoria32

Rob è qui said:


> Hi everyone, I hope this topic will not closed, I try to open a discussion that widely interest everyone... I hope this matter is in your forum rules...
> 
> What you think about health services in your country? Are they well-organised, can they support you when you need help? have you had bad health services in hospitals or in private clinics?
> 
> What's the situation in your country?
> 
> Thanks in advance


Despite occasional screeching from the right-wing, and from Big Business, most notably big drug companies, who want their particular drug to be subsidised by the government, our health system is brilliant! It is what would be called a fully 'socialised' system - although not really - one thing I would like to see, is that glasses and dental work are included (presently they are not). I'd rather wear Harry Potter NHS glasses than go without! That being said, whether I get hit by a bus, and break a leg or have a CVA, I will get the care I need, and not ever have to worry about the cost.
You may hear stories in our media about people with cancer having to wait months for radiotherapy, but that is nonsense!(Most of our media are foreign-owned..) 
 People with life-threatening conditions automatically go to the head of the queue. 
My son is a student nurse, and he is working in the system, and so I am getting the chance to see it from the other side, not just as a patient, and I am so much more impressed with it than I was - even as a patient, I was very happy with it.

I am talking about New Zealand, I had better say... 

Vicky


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## ziu

I had my appendix removed a couple of years ago: Woke up one morning with severe abdominal pains, went to the local clinic and was able to see a doctor immediately. A few hours later I was in a hospital bed recovering from the operation. The attention from the nurses while I was there was excellent and even the hospital food wasn't bad. Total cost: $0.

Despite what a previous poster said, the NHS in the UK is probably one of the best things about being a citizen of this country. I would not like to be a poor person living in the USA.


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## Trina

Although many complain about it (and often with good reason), IMHO our healthcare system, on the whole, is wonderful.
Anyone taken to Emergency, is treated regardless of whether or not they have private health insurance.



> Under Medicare, the Australian and State governments also jointly fund public hospital services so they are provided free of charge to people who choose to be treated as public patients. Australian Government funding of the 30% Rebate and other key incentives support people’s choice to take up and retain private health insurance.         People make their contribution to the health care system through taxes and the Medicare levy based on their income, and through private financing such as private health insurance.
> The aim of the national health care funding system is to give all Australians, regardless of their personal circumstances, access to health care at an affordable cost or at no cost, while allowing choice for individuals through substantial private sector involvement in delivery and financing.


 Source: http://www.medicareaustralia.gov.au/about/about_us/aus_health_system.shtml

Something I do find curious here is the following scenario...
My father-in-law had private health cover but chose to be treated in a public hospital  (because that is where the best surgeon in that particular field operated). He shared a room with another patient who was having the same surgeries and treatments but did not have private health insurance. At the end, my father-in-law had a bill to pay (the gap between the cost of the surgeries/treatment etc and what his insurance company paid). The other patient (with no private health cover) had no bill to pay whatsoever.


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## Victoria32

Trina said:


> Although many complain about it (and often with good reason), IMHO our healthcare system, on the whole, is wonderful.
> Anyone taken to Emergency, is treated regardless of whether or not they have private health insurance.
> 
> Source: http://www.medicareaustralia.gov.au/about/about_us/aus_health_system.shtml
> 
> Something I do find curious here is the following scenario...
> My father-in-law had private health cover but chose to be treated in a public hospital  (because that is where the best surgeon in that particular field operated). He shared a room with another patient who was having the same surgeries and treatments but did not have private health insurance. At the end, my father-in-law had a bill to pay (the gap between the cost of the surgeries/treatment etc and what his insurance company paid). The other patient (with no private health cover) had no bill to pay whatsoever.


which is the main reason why I think it is foolish to have health insurance in Australia/New Zealand... Despite newspaper scare stories, it just isn't necessary! 
Vicky


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## maxiogee

Trina said:


> Something I do find curious here is the following scenario...
> My father-in-law had private health cover but chose to be treated in a public hospital  (because that is where the best surgeon in that particular field operated). He shared a room with another patient who was having the same surgeries and treatments but did not have private health insurance. At the end, my father-in-law had a bill to pay (the gap between the cost of the surgeries/treatment etc and what his insurance company paid). The other patient (with no private health cover) had no bill to pay whatsoever.



Did your father-in-law ask the other patient how long they had to wait to see this surgeon. I'll warrant there was a lengthy waiting list to see him/her as a public patient. Your father-in-law got to see the surgeon as soon as he needed to. The surgeon only commits to do X% of their time seeing public patients, and there are generally many more of these than there are of private ones.
Your father got to specify which doctor treated him. The other patient got the best by chance - his next door neighbour was probably treated by the worst surgeon practising in the state.


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## roxcyn

Thomsen said:


> I just thought I would add that there is a huge problem hospitals in the USA have.  Poor people without medical insurance can't afford to see a doctor, so they wait until they have life-threatening conditions, go to the hospital and skip out on the bill.  Some hospitals go *bankrupt* and others are understaffed as a result.  At the very least, some sort of national plan to provide preventive care would go a long way toward alleviating that.



This statement is not true.   Hospitals cannot deny treatment if someone does not have insurance in the USA.  Many times if someone were to tell the hospital "I am sorry I don't have a job and I don't have insurance."  They work with them, they forgive most of the bill.  Actually, there are many people that donate money to hospitals so that people that cannot pay get these monies.  There are also clinics which charge reduced or free costs.  

Moreover, if people tell their doctors that they do not have insurance and have little money, most doctors do not want to lose a patient.  These doctors can file a "loss" of money on their taxes, so some doctors will work with patients to accept "x" amount of money.  I had to do that with one oral surgeon when the insurance would only pay so much, and he agreed and said he would just file it as a "loss" on his taxes.  Therefore, I think if someone doesn't have insurance he or she already knows about this information?


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## roxcyn

ziu said:


> I had my appendix removed a couple of years ago: Woke up one morning with severe abdominal pains, went to the local clinic and was able to see a doctor immediately. A few hours later I was in a hospital bed recovering from the operation. The attention from the nurses while I was there was excellent and even the hospital food wasn't bad. Total cost: $0.
> 
> Despite what a previous poster said, the NHS in the UK is probably one of the best things about being a citizen of this country. I would not like to be a poor person living in the USA.



Actually in the USA, if someone says they do not have a job and/or insurance the hospital will work with that person.  It will probably not be as good as the total cost of being nothing, but at least it is a start for the USA.


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## Trina

maxiogee said:


> Did your father-in-law ask the other patient how long they had to wait to see this surgeon. I'll warrant there was a lengthy waiting list to see him/her as a public patient. Your father-in-law got to see the surgeon as soon as he needed to. The surgeon only commits to do X% of their time seeing public patients, and there are generally many more of these than there are of private ones. Yes, this is certainly the case when it is considered to be "elective surgery" (such as hip replacements) But in this case, the operations were considered life-saving, so they both were admitted and treated immediately.
> Your father got to specify which doctor treated him. The other patient got the best by chance - his next door neighbour was probably treated by the worst surgeon practising in the state.Again, yes this often occurs, but in this case they were operated on by the same surgeon. (My father-in-law, although he had private cover, chose the public hospital because the surgeon he wanted, worked in that public hospital)



The points you have raised are the reason why I have private cover. If I need surgery or hospitalisation, I have the choice of where / when (to a certain extent) and who, particularly if I need elective surgery. (A private room's not bad either!)

But I suppose it does "cheese-me-off" that although my husband and I pay AUD$220 a month for private health care and pay a percentage of our incomes to help fund the public system, we still have to fork out "the gap" that our insurance does not cover.


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## Hockey13

The Australian system actually seems not all that horrible. Considering the logistical constraints of the system (i.e. there are only so many doctors and hospitals), you _can_ pay for better care, but you are not denied care ever if you do not pay for health insurance. Seems like a pretty good stepping stone for the U.S., in my opinion. It certainly is better than not getting any care at all or hoping the hospital will forgive some charges. Despite what rox says, you can easily run up some serious bills at a hospital without insurance.


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## djchak

roxcyn said:


> This statement is not true.   Hospitals cannot deny treatment if someone does not have insurance in the USA.



http://www.ama-assn.org/amednews/2005/07/25/bisb0725.htm

"In what is being called New York's largest-ever hospital bankruptcy, Saint Vincent Catholic Medical Centers has filed for Chapter 11 protection, citing mounting debts and falling revenues."

Do you want me to find 10 more examples?


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## mirx

Just for the record.

In Mexico one can not afford to get sick, as simple as that. Let alone need a surgery, those are luxuries you cannot ever think of.

Although we have free health care system, that is to say that as long as you work you can go to hospitals (run by the federation of course) and get as many boxes of pain killers as you want. The truth, is you will never get more than just pain killers, so let's say you have a problem, your arm hurts you go to the hosiptal and they give you pain killers, you come back after the treatment because the pain is still there, they give you more pain killers and probably arrange an apointment with X'Rays and some blood analysis, since everything's always overbooked the soonest apointment they can get you is in two months. All this time you survive with pain killers and you witnessed how a protuberance grew on your left arm. After two months you are back in the hospital, but guess what? They changed the doctors and a lot of papers are missing because of the move. Your file is lost!!!. So you start all over again, now the pain killers don't suffice but you have no option left. Stick to the pain killers and back to the IMSS in a couple of weeks, more studies and more work-days lost. You flirt with the desk clerk and probably she can get you an sppointment sooner, somehow you manage to get an appointment in 5 weeks, wow that's great isn't it? 
The protubernace in your arm is worst than ever, it has become an open wound. The 5 weeks slowly passed, you are finally there, but ooops, it seems that your blood tests are more than 3 weeks old (that´s right because you couldn't get an appointment sooner) so they are useless!!! You have to get tested again. Your pain is nothing compared to the moral wearing you have been going through, the humillation and the anxiety you have been exposed to. By now you have lost sensibiliyt in your hand and cannot move your fingers, but that doesn't matter anymore!!!. A few nights after that you awake in the middle of the night, the pain is unberable, they accept you in the emergency room but you still have to wait a few hours because there are other more urgent emergencies. By now you are high on pain killers. They get you a bed and tell you that you have to wait because the doctor that's been seeing you  is on hoilday an won't be back in about two weeks. Another doctor comes the next day and tells you that you had a tumor in the upper-arm and that by now it has affected all the arm, an amputation is inminent there's nothing they can do now. But If you had gone to the hospital 2 months before (it´s been a year since you first started going) they surely could have helped you. You go to surgery and something goes wrong. No one told them that you were allergic to some substances they admininstered you. It´s too late now. You die.

But well, who cares about it, ahhh? Anyways this only happens to the middle-working class, only to some 72 million of mexicans which I am not part of. So why should I worry?. It's easier and much more comfortable to pay a private clinic and get some pills that will disolve the protuberance in my arm, yes, this is way easier than to worry!!! And besides they do have FREE HEALTH CARE!!!


PS: This only happens to the middle class, poor people and extreme poor people whcih make about 20 millions of the population are lucky enough to not be part of the "free health care system", they may need to sell a TV or a radio and pay a "public" clinic and in a month or two they'll have a new TV or a new radio and they will also be healthy.


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## Grobar

Im not sure my Country (Bosnia/Hercegovina) has something that someone would call a Healthcaresystem.
But Germanys HEalth care system is Great....myabe it would be better to say that it was great once....step by step the system is cut down...


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## djchak

No healthcare system is perfect.

In the US the actual healthcare is great. It's the system that fails the working lower middle class poor. If you are truly broke you will probably get great care and not get charged much. It's probably not as bad as what it's made out to be, but it does need reform. I'm paying about $350 for a well known PPO, with worldwide coverage. Most people can get an HMO for less.

There are however, many exceptions.

I honestly think that our government (in the U.S.A) should pass laws that make very basic and emergency room healthcare affordable to everyone. But just that seems like a huge task.


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## roxcyn

Hockey13 said:


> Despite what rox says, you can easily run up some serious bills at a hospital without insurance.



No, don't get me wrong, I never said they bill wouldn't be a lot.  But, then you have to consider which hospital it is.  But, as far as I know, it is illegal for a hospital *to deny people treatment regardless if he or she has no insurance*.  I think it goes back to the 1900s and up to around the time of civil rights movement.  Hospitals would deny the treatment of black patients and they would have to go to hospitals that did not have good technologies or many resources (such as small clinics).  Now, as for each individual hospital forgiving costs, I can only speak for the hospitals in my city.  I know that they advertised that they care about their patients and that they have funds set aside from donations to help needy patients who lack insurance.  Sorry, if I sounded as if I was saying that all hospitals do that.


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## roxcyn

djchak said:


> http://www.ama-assn.org/amednews/2005/07/25/bisb0725.htm
> 
> "In what is being called New York's largest-ever hospital bankruptcy, Saint Vincent Catholic Medical Centers has filed for Chapter 11 protection, citing mounting debts and falling revenues."
> 
> Do you want me to find 10 more examples?



As I said in my previous post, it depends on the hospital.


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## roxcyn

djchak said:


> No health care system is perfect.
> I honestly think that our government (in the U.S.A) should pass laws that make very basic and emergency room health care affordable to everyone. But just that seems like a huge task.



I would like to see the USA do something similar to the UK.  Okay, so higher taxes, but at least everyone would be covered. .


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## TRG

roxcyn said:


> I would like to see the USA do something similar to the UK. Okay, so higher taxes, but at least everyone would be covered. .


 
This is a concern (higher taxes), but I'm not sure this has to happen. First, the percent of GDP spent on health care in the US is already higher than other countries. However, not everyone in the US is paying for the health care they receive. People who chose not to buy health insurance or cannot afford it still get medical attention when they need it, so it is being paid for by taxpayers or by people who do pay for their health care. Somehow we need to bring all the uninsured into the "system" without having costs go up any more. Unfortunately, the "system" is not doing a good job of controlling costs and the solution to this problem is not apparent other than to reduce the availability or quality of health care that we have now. This is one of the main things that people fear about going to a government managed health care system.


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## Lugubert

The quality of medical care in Sweden is second to none. And it's practically free.

For a visit to a GP, it's (I think) around $40 (unless you are destitute, in which case I suppose it's totally free). There's a rather low maximum amount per year if you need many consultations. Any lab tests, X-rays, even MR scans are included. For prescribed medication, there's also a similar maximum amount per year.

Any care for minors (for them including dentistry) is totally free.

For some procedures in some regions, there are waiting lists, but there are increasing efforts to allow patients extraregional care if there are hospitals without waiting times. It might even be(come?) possible to go to other EU countries for care under Swedish financial rules.

I had a stroke. In less than half an hour, my then fiancée having realized what had happened, an ambulance had brought me to a stroke specialist unit. (I was fortunate enough to live in a major city.) First, the stroke ward for a week or two, then a rehabilitation ward for almost a month. Medication, two MR scans and whatever. I was surprised that I got a bill! The amount was, however, less than what I in a healthy state would have used for food only for that time.

I'm now as healthy as can be, considering that the stroke resulted in a small brain infarction.

I'm not saying that the quality of health care is worse or even necessarily more expensive in all other countries, but our system is a good reason for me to stay a resident of this country.


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## TRG

Lugubert said:


> The quality of medical care in Sweden is second to none. And it's practically free.


 
It sounds like you have an excellent system in Sweden. I assume that the state pays most of the cost so by "free" you mean little or no additional out of pocket cost to the consumer of health care services. Are hospitals and doctors operating as private enterprise or is the entire medical system owned and operated by the state? The primary argument against this type of health care system in the US is that government run enterprises tend to be inefficient and ineffective at delivering services; private enterprise is almost always viewed as the most efficient way to get anything done. I agree that this is true for many things, but I'm not so sure about medical care. In fact, based on the cost of health care in the US I'm beginning to wonder if private enterprise may be the least efficient way to delivering health care.


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## Hockey13

TRG said:


> In fact, based on the cost of health care in the US I'm beginning to wonder if private enterprise may be the least efficient way to delivering health care.


 
 

You're really _trying_ to bring out the economist in me, aren't you???  

The U.S. system of healthcare is one of, if not _the_ best in the world...if you have the money. In economic terms, that is the very idea of efficiency. If you bring in the government to run the system, you almost always make it less efficient in the sense that the overall process will cost more, but the average person will have to pay less. There are ways to get around it, of course, but none of them are free. There are also cultural issues to reckon with. Some cultures might place a heavier emphasis on the greatness of being a doctor and it might cost a lot less to become one in Sweden*. Who knows? 

I tried, I really tried not to say anything about the comment about Sweden's medical quality being the best in the world. But the facts are the facts. If you have the money, going to the U.S. for your health is something that has been done time and time again.

*One of the ways, in my opinion, to decrease the cost of total healthcare is to subsidize the cost of  medical school...that's what I meant by that comment.


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## roxcyn

Lugubert said:


> The quality of medical care in Sweden is second to none. And it's practically free.


  Isn't that because Sweden is often cited as having one of the highest tax rates in the world?  I recall reading that before, and I know Roxette (Per Gessle and Marie Fredriksson) are often said as paying the highest taxes for music artists.


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## TRG

Hockey13 said:


> You're really _trying_ to bring out the economist in me, aren't you???
> 
> The U.S. system of healthcare is one of, if not _the_ best in the world...if you have the money. In economic terms, that is the very idea of efficiency. If you bring in the government to run the system, you almost always make it less efficient in the sense that the overall process will cost more, but the average person will have to pay less. There are ways to get around it, of course, but none of them are free. There are also cultural issues to reckon with. Some cultures might place a heavier emphasis on the greatness of being a doctor and it might cost a lot less to become one in Sweden*. Who knows?
> 
> I tried, I really tried not to say anything about the comment about Sweden's medical quality being the best in the world. But the facts are the facts. If you have the money, going to the U.S. for your health is something that has been done time and time again.
> 
> *One of the ways, in my opinion, to decrease the cost of total healthcare is to subsidize the cost of medical school...that's what I meant by that comment.


 
I agree that quality of care in the US is probably the best in the world. However, I do have some personal experiences where quality was lacking in the utmost, but I won't bore you. The issue is not quality but cost. I believe it is generally accepted as fact that in the US we spend about twice as much for health care as the average in other economically developed countries. Since the US doesn't enjoy any particular advantage in any of the measures of health (life expectancy, etc.) where is the benefit from the extra cost. I fear that it is being spent on administrative costs, legal costs, unnecessarily diagnostic work, and other factors which don't necessarily contribute to delivered health care services.


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## roxcyn

TRG said:


> I fear that it is being spent on administrative costs, legal costs, unnecessarily diagnostic work, and other factors which don't necessarily contribute to delivered health care services.




And don't other countries have policies what drug companies can charge for medicines?  Many medicines are very expensive, and that is another part of hospital care/health care.


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## Hockey13

TRG said:


> I agree that quality of care in the US is probably the best in the world. However, I do have some personal experiences where quality was lacking in the utmost, but I won't bore you. The issue is not quality but cost. I believe it is generally accepted as fact that in the US we spend about twice as much for health care as the average in other economically developed countries. Since the US doesn't enjoy any particular advantage in any of the measures of health (life expectancy, etc.) where is the benefit from the extra cost. I fear that it is being spent on administrative costs, legal costs, unnecessarily diagnostic work, and other factors which don't necessarily contribute to delivered health care services.


 
There is always a reason why things cost more here than in other countries. In my opinion, some of it has to do with the cost of education. In the U.S., the cost of becoming a doctor is second only to paying one.


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## roxcyn

Hockey13 said:


> There is always a reason why things cost more here than in other countries. In my opinion, some of it has to do with the cost of education. In the U.S., the cost of becoming a doctor is second only to paying one.



Then maybe we should adopt a more European model of government in the USA?  School fees lowered, medical fees lowers, and higher taxes.  That seem okay to me.


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## Hockey13

roxcyn said:


> Then maybe we should adopt a more European model of government in the USA? School fees lowered, medical fees lowers, and higher taxes. That seem okay to me.


 
Tell that to the Republicans.  

I am personally half-Libertarian, half-Democrat. It's an odd combination, but I'm 100% for personal freedoms (something that is absolutely great about the Libertarian Party is that they don't shy away from the logical arguments for the legalization of Marijuana and such things) and I have a social conscience when it comes to things like healthcare and education. 

I'm also not so against bureaucracy in many places in the government. Bureaucracy means inefficiency. An efficient government does what it wants as quickly as it wants. The Nazis, for instance, had a fantastically efficient government.

Back on topic: As I suggested before, I think one way this whole thing could be made simpler (though perhaps not providing universal healthcare) is to make it much cheaper to attend medical school. I can only imagine how much tuition could be paid for if we scrapped one B-2 bomber (priced at about $2,000,000,000) or some of its munitions like the AGM-158 JASSM (estimated to cost $300,000 to $700,000). If only we subsidized students who major in education and medicine, I would be a happy man. Those two fields are, in my opinion, the two most crucial to a society. Having more (and more qualified) teachers and doctors who didn't sell body parts to become doctors could only help our society.


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## djchak

roxcyn said:


> Then maybe we should adopt a more European model of government in the USA?  School fees lowered, medical fees lowers, and higher taxes.  That seem okay to me.



I really don't think it will happen. And if you wanted those things, wouldn't it just be easier to move to Europe?

If there are solutions, it will have to be ones that can be easily and rapidly implemented in the type of systems we have.....

Maybe we can learn from the good things and the mistakes of different systems around the world.... but let's face it, something more like Canada's NHS is much more implementable (certain aspects of it) then then NHS of most Scandanavian countries.


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## Lugubert

roxcyn said:


> Isn't that because Sweden is often cited as having one of the highest tax rates in the world?


Of course that's the way it is ultimately paid. But I think we get good value. It sure doesn't hurt to know that even if we in the end have paid more than we have cost, it has been like paying via a separate insurance system, with the added benefit that we know that even people who can't themselves afford the net cost for a major procedure will get superb care.

I should add that we have a mixed system. I have referred mainly to the government part of it. A few hospitals are run by commercial entities. I think this is healthy and a competition that pushes efficiency and quality in the general system. Some GPs and specialists work outside of hospitals and health care centres. Some of those are accredited to the system, and so visiting them costs no more than if you go to the "official" docs. The totaly free ones are of course more expensive.

People who themselves can afford it and think it's useful or are, for example key personnel in a large company, may invest in insurance to skip any queues. This raises political concerns. Some people think that it's unfair to get ahead of others because you're rich or have secured an affluent employer. I will never be in that situation where such an insurance might be within reach, so I think that I'm fairly unbiased when I say that the more of those, the better: they jump the system by _getting care outside of it_, so they in reality free it up for others.


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## Thomsen

roxcyn said:


> This statement is not true. Hospitals cannot deny treatment if someone does not have insurance in the USA. Many times if someone were to tell the hospital "I am sorry I don't have a job and I don't have insurance." They work with them, they forgive most of the bill.


 
OK, you are essentialy saying what I am saying which is that overworked hospitals end up serving as primary care as well as emergency care providers and especially in poor urban areas close because they lose money.  I am not blaming anyone and certainly didn't get close to implying that anyone would be turned away.

It is good to note that in the USA charitable organizations and non-governmental organizations pick up a lot of slack by providing services that the government doesn't.  For example, the Red Cross collects blood and some clinics cater to low-income clients.


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## El Torero

What do I think about Polish health service... well... it sucks...
Queues are REALLY long, cures are VERY expensive... one can really rely on private clinics only. 
Our situation isn't very similar to Swedish - we do pay high taxes, but get a crappy medical care. Mostly emergency comes too late to help people, nurses and doctors are paid far too little so they emigrate.
Hospitals can't afford better equipment. that shitty situation is a sad leftover after our Eastern Friends unfortunately... :]


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## don maico

I must say that i am proud to live in a country where the stated aim is to provide health care to ALL its citizens regardless of ability to pay. Having said that of course there have been problems which have largely been assocaited with lack of funding, poor organisation and , most importantly, increasing demand, The latter is particularly so because new treatments have been discovered, some of which are very expensive. Ditto some new drugs that have come out which are used to treat life threatening conditions like cancer. 
I get a bit annoyed when people complain about the NHS because I know the staff generally work very hard and very conscientiously. Unfortunately the British tendency is always to look for the negatives and to want something for nothing.
One downside is the fact that too many of our surgeons work in the private sector as well where they can make a lot more money. It doesnt take a genius to work out that they do their private  before their public work.This should be stopped
We spend about 10% of our GDP on heaslth care which when compared to France and Germany - 12% and USA-14% seems not enough and yet the Brits bellyache about the amount they do pay prefering to lash out on TVs holidays abroad, you name it! Health care goes way down the list. This is because they take it too much for granted. I would like to see a system where by we all pay a certain amount ( as we do now) to the Government to provide  a basic safety  health programme topped up with membership payments to our local health clinics. This would ensure that we would demand the service we require as the notion of something for nothing would no longer be there. In other words it would be more like any private service but without the profit motive.
I remember reading a rather sad story about this American guy who had worked hard all his life and served his country well but never made much money. As he grew older he developed a heart condition which necesitated an operation. He neither had the funds or insurance cover necessary, He did, though, own his own home.This meant making a choice between selling his home in order to get the operation or dying  with a roof over his head, He was ,indeed, a bitter man , feeling his country had deserted him at his time of need. I must admit I find it very hard to understand the American reluctance to embrace socialised medicare. Given its huge wealth it could well support it . It does , though, seem that too( Republicans?) many dont view such care as a right.


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## JackieCane

I'm glad to live in Spain because of the Health Services. Yes, we have to wait months to see a dermatologist or a ginecologist, but if you need a new heart or a new kidney you can get it without paying ANYTHING extra, and also if you need an urgent surgery. You have to share your room, but it doesn't mind, you're there for a cure, not for a holiday!  

My mom had a breast cancer two years ago, and she didn't have to pay for the surgery, neither quimiotherapy and radiotherapy, or all the medicines. We are (VERY) working class. Whithout that Health Services, my mom will be dead.


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## don maico

JackieCane said:


> I'm glad to live in Spain because of the Health Services. Yes, we have to wait months to see a dermatologist or a ginecologist, but if you need a new heart or a new kidney you can get it without paying ANYTHING extra, and also if you need an urgent surgery. You have to share your room, but it doesn't mind, you're there for a cure, not for a holiday!
> 
> My mom had a breast cancer two years ago, and she didn't have to pay for the surgery, neither quimiotherapy and radiotherapy, or all the medicines. We are (VERY) working class. Whithout that Health Services, my mom will be dead.


My sister lives in Alicante and she recently had a brain tumour removed. She said the care was excellent. She didnt have to pay anything for it


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## Danielo

I should disagree with JackieCane. I am Spanish but based in France.

It is true Spanish HCS are free for everybody (even most of undocumented migrants) but quality is far to be the rule. Emergencies in public hospitals at big cities like Madrid are very far from a minimum quality standard (rooms shared by 6-8 persons, lack of staff, loads of noise, no intimity, etc.) You have to wait months even years for a quirurgical intervention.  It is really a good thing to have a free access for deprived people but I don't agree with the fact that accomodated people do not pay a contribution for health services.   

In fact in Spain private health insurances work as an alternative access to better and faster health services. Often, the same doctors are working in the morning for public services and in the afternoon foor private clinics.


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## Danielo

And then France.

French people complain quite a lot (as it's maybe part of their culture of _râleurs) _but their Health care services are really good. 
Hospitals I visited were quite new and clean (when my daughter was born a couple of years ago, everything was perfect at a small town of 15k unhabitants). Emergencies waiting period is reasonable. Care and medical attention are fine. Doctors take time to listen and explain everything to you.

HCS in France are not completely free. Apart from deprived people that have a full and free access, everybody else should pay 1/3 of the fee. Private insurance cover this 1/3. 
I was first shocked and even angry when I came from a "Spanish never pay for health culture." Now I find this system is much better than my home country one.
Salud for all


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## JackieCane

Yeah, that's the point, if you don't want to wait and have enough money to pay a private insurance, do it. Anyway if you have a serious desease you have to go to a Public Hospital, because they have the best technology. But we are 20 million of spanish workers that earn less than 1000€ a month, so we really need public services...

(You can find that in the Hacienda Ministry web page...)


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## Pedrovski

Public health-service (at least in Portugal) should be privatized and thus avoid the bureaucratic nightmare that currently exists. Not only does it operate badly and inefficiently, it also creates a huge hole in the public finances.

The State should instead subsidise health-care insurance for the very poor. That way we'd have better services AND less wasted government expenditure.

Of course, things obviously don't work as well in practice, but anything is probably better than the current status quo.


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## Danielo

You are right Jackiecane. 20 million people in Spain earn less than 1k euros a month. 
However, you can see everywhere in Spain that many people (and I am sure that some of these 20 millions are involved) have brand new cars, last generation mobile phones, all kind of electronic devices, etc. Moreover, bars and restaurants are always full of people.

I agree, public services are necessary but afterwards we can choose how we spend our money: I don't know you but I know fairly quite a lot of Spanish people driving a 40 thousand euros car and going for free health services at the public hospital.


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## JackieCane

I would agree if privatization will guarantee for every one things like brain surgery, cancer treatment or transplants. But i'm sure that things wouldn't work like this. In Spain, half of the population will have USA health services and the other half Mexico health services. And I'll be on Mexico's side. Sad but true.


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## jess oh seven

I can have my organs ripped out for free, but when I need a form filled in they can charge over £100.


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## xarruc

I think the concept of an national health system is great. I think it must be terrible to have to chose between having a lump that is probably nothing checked over and buying little Jimmy the trainers he needs. I know how hard it can be to get people, particularly us men, to get a check-up even when it's free.

On the other hand, some kind of nomnitive payment is not bad to discourage the time-wasters and just to remind people that it's not free.


However, as I see it, the big problem with free health services stem from the following facts.

1. Everybody will die
2. Almost nobody wants to die
3. The cost of keeping someone alive increases as they approach their death.
4. The amount of money that is healthy for the economy to spend on health is not infinite.
5. Every member of society, left to their own devices, would find their own equilibrium between expenditure today and saving for a medical emergency in the future (saving or insurance payment).

A nationalised health service must make the budget allowance based on 4 and 5, IE what the people want and want is good for the economy.

Due to 1 and 3, as medical research advances it becomes possible to keep people alive longer and so costs will always rise.

6. This means that the medical chiefs have to allocate their budgets in ever more difficult ways - one chemotherapy equals 100,000 sticky plasters say. What's a life worth? The result is an overstretched service.

Because of 2, politicians always want to be seen as improving the health service, because of 4 and 5 they are restricted from solving the true problem - a lack of funds*. Instead they make hollow statements here and there and announce this and that. The only winners are the consultants. 

Whilst our economies grow nicely its OK, the government can tax more and get by. It's no coincidence that the countries that according to this thread have the best health services also have the highest taxes.

I think the problem will come if our economies take a down-turn. Suddenly a penny on fuel is a big deal. What needs to be done is to be open about what a life is worth. To openly discuss and agree on what can sustainably be provided for free**. If you are 40 and have stomach cancer do we treat it? Do we still if you're 80? I think it is only through this that the national health services can survive. Is it better that elderly people needing a hip replacement get it as a dodgy hip causes discomfort, or they suffer the dodgy hip for four years to undergo radiotherapy that prolongs their life by just 4 months? These decisions are currently being made, just behind closed doors and not by us.

But of course our leaders aren't ever going to say that. They patch up the service and hope it will last until they're out of power. Then they can use it to lampoon the competition. 


*The UK has a nice little trick up its sleave though. Borrow the money! Invented by the Tories and now welcomed with open arms by Gordon Brown. The scam works like this: Get somone else to build the hospital and then pay them back slowly afterwards. Whats the difference between this and a bank loan you ask? - It doesn't appear on the balance sheets and so the economy looks healthier than it is. Fantastic. Even better is that when the shit hits the fan Labour will be out of power! Its a win-win. Oh no, I forgot one more important bonus. After two years at the treasury/health service, the guy who controls the contracts jumps ship to a consultant or PFI company and tells them exactly how to win all the lucrative contracts. Everybody wins! Fantastic!


**I assume insurance companies do that already and customers choose their policy based on this and what they can afford to pay.


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## djchak

don maico said:


> I remember reading a rather sad story about this American guy who had worked hard all his life and served his country well but never made much money. As he grew older he developed a heart condition which necesitated an operation. He neither had the funds or insurance cover necessary, He did, though, own his own home.This meant making a choice between selling his home in order to get the operation or dying  with a roof over his head, He was ,indeed, a bitter man , feeling his country had deserted him at his time of need. I must admit I find it very hard to understand the American reluctance to embrace socialised medicare. Given its huge wealth it could well support it . It does , though, seem that too( Republicans?) many dont view such care as a right.




Um, where did you read this? It sounds like a bit of a tall tale.

The fact is, people without any healthcare insurance usually get it written off, almost completely. The problem is the working poorer classes with minimal health insurance with high deductables. 

You mentioned that this person "served thier country". Are you saying this guy was a veteran? Ever hear of a "veteran's hospital"? Or are these only found in the states?

Now, the 170 VA hospitals...funded at 19 BILLION...in the States aren't known for being problem free...but generally, they are a good thing.


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## don maico

djchak said:


> Um, where did you read this? It sounds like a bit of a tall tale.
> 
> The fact is, people without any healthcare insurance usually get it written off, almost completely. The problem is the working poorer classes with minimal health insurance with high deductables.
> 
> You mentioned that this person "served thier country". Are you saying this guy was a veteran? Ever hear of a "veteran's hospital"? Or are these only found in the states?
> 
> Now, the 170 VA hospitals...funded at 19 BILLION...in the States aren't known for being problem free...but generally, they are a good thing.


i meant he worked hard for his nation nad never asked for anything until this hour of need.He shared it in an Ebay chat room. I have no way of knowing the veracity of his woes but it struck me as poignant at the time.It might of been hius reaction to  what was a predominately rightwing  chat room peopled by Republican sympathisers who quite clearly didnt see healthcare as a right and who didnt seem to give a rats --- that some people fall on hard times.Thats all I can say.


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## Thomsen

don maico said:


> i meant he worked hard for his nation nad never asked for anything until this hour of need.He shared it in an Ebay chat room. I have no way of knowing the veracity of his woes but it struck me as poignant at the time.It might of been hius reaction to what was a predominately rightwing chat room peopled by Republican sympathisers who quite clearly didnt see healthcare as a right and who didnt seem to give a rats --- that some people fall on hard times.Thats all I can say.


 
I think that is a good point.  Many Americans don't see healthcare or employment as a right of citizenship.  Furthermore, many wouldn't consider someone who is hard working as working hard for their nation.  We are a nation of patriotic individuals.  It's a very different philosophy than a communitarian one, but it probably grew out of the frontier mentality when the only person you had to rely on was yourself and the government was a long way away.   You have to remember too that America saw itself as the last bastion against Communism for a long time and of course many people still don't see the nuances of meaning between socialism and communism.


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## TRG

Here is an interesting question although I'm not sure it belongs in this thread. In the US it takes 10 to 15 years to get a new drug tested and approved by the FDA (Food and Drug Administration). It is one of the reasons why drugs are so expensive. If you have a life threatening condition or you are elderly, say 70 years old, you do not have 10 to 15 years to spend waiting for a drug that might save your life or give you better health late in life. So why don't we allow people like this to have early access to new drugs as long as they meet some reasonable standard of safety? It would also serve as part of the testing process to ensure the drugs are safe for the general public. But if you want to be a human guinea pig, why not?


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## Victoria32

TRG said:


> Here is an interesting question although I'm not sure it belongs in this thread. In the US it takes 10 to 15 years to get a new drug tested and approved by the FDA (Food and Drug Administration). It is one of the reasons why drugs are so expensive. If you have a life threatening condition or you are elderly, say 70 years old, you do not have 10 to 15 years to spend waiting for a drug that might save your life or give you better health late in life. So why don't we allow people like this to have early access to new drugs as long as they meet some reasonable standard of safety? It would also serve as part of the testing process to ensure the drugs are safe for the general public. But if you want to be a human guinea pig, why not?


That's not an unreasonable idea, TRG.. If it is properly monitored and there is totally informed consent, the patient knowing that there will be a risk. 

Otherwise, well, not a good idea at all!

Vicky


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## xarruc

> That's not an unreasonable idea, TRG.. If it is properly monitored and there is totally informed consent, the patient knowing that there will be a risk.


 
That already happens to some extent. First you have find a suitable chemical that no one else owns, then to proove that it will probably work. Then you have to proove that it probably wont cause any major side effects. Then you can test it in people with nothing to lose. Of course, there are few people with nothing to lose. 5 mildly painful years are better then 5 excruciating ones. 

It can be quite upsetting when you read the cold report of an experiment with such new drugs and realise that only 4 of the 10 patients survived the length of the test.


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## Toepicker

Interesting to read the issues raised on this thread. I work within the state healthcare service in the UK (NHS). Some points I would make are:


There is a constant barrage of negative press from the media in the UK, with endless tales of horrific mistakes, blunders and inept care. Sure enough there are problems, but the overwhelming majority of treatment episodes are high standard but never acknowledged. A colleague of mine recently quipped that the Brits want a gold plated healthcare system paid for with brass tacks! Everyone moans about taxes, but then complain if efficiency drives lead to closing down a clapped-out hospital in favour of a new state-of-the art one ten miles down the road which offers better services with full back-up for clinical emergencies.
The private healthcare system generally cherry-picks. ie. will insure young fit patients cheaply compared to older patients, and woe betide you if you have a long-term mental health problem -you won't see the private sector for dust!
The NHS is currently undergoing a very profound change, with provider services slowly having to compete for contracts with general practitioners on a value for service basis. Some service providers could disappear if they are not deemed as up-to-scratch. Hopefully, patients will still have free care, as I could not imagine any political party being elected which dared to force patients to pay. Eg to visit your GP.
One very important aspect of healthcare which has not been mentioned much on this thread is that of preventative medicine. We know why a lot of medical conditions arise and that leading a healthier lifestyle will be an investment in better health as we age. Whilst the NHS has a long way to go in this field, there have undoubtedly been great strides towards this. In Diabetes care, for instance, it is known through huge amounts of research that patients diagnosed with this condition can lead full healthy lives if their blood sugar levels are closely controlled. There is no reason why a diabetes patient is doomed to die young from kidney failure or gangrene, but it takes a lot of monitoring and checking to ensure patients keep to the straight and narrow. Next step in this field is trying to prevent people developing diabetes in the first place, and it is interesting that chocolate sales are down and fresh fruit and vegetable sales are up in the UK! Maybe the message about obesity is hitting home at last-but it is a long haul!
Personally, I think the UK health service is improving, but it is a bottomless pit financially, as has been mentioned by other contributors to this forum. I think a national or state-run service is probably better, although at arm's length, without too much interference from politicians!


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## Etcetera

The Russian health service is quite famous among the citizens for its bad organisation, disrespect for the patients, and its being absolutely free of charge. Yes, free. But everyone knows that, if you can afford it, it's better to pay for a good clinic, experienced doctors and good medicines (which simply cannot be obtained for free). 
It's been quite a long time since my last visit to a "free" dentist. In the last five years, I strongly prefer to go to private dentists. Of course, I'll pay much more here, but I'll get all the attention I would never receive at a "state" dentist's.


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