back to article Healthcare: Look anywhere you like for answers, just not the US

A few weeks back I pointed out that the US has the second largest social welfare system in the world. This produced a certain amount of pushback (journalistic speak for me whining to El Ed that you commentards are shouting at me) over the fact that a good part of that is the woeful healthcare system in said US. So, as the New …

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  1. OzBob

    So remind me again

    Why can't we tax fat bastards more than thin people, to cover their medical expenses?

    1. Any mouse Cow turd

      Re: So remind me again

      While we're at it, why don't we also tax those who exercise to cover physio and sports injuries too.

      1. Charles 9

        Re: So remind me again

        Sports injuries are one reason why top-class athletes get paid well. Athletes run the risk of overexerting and injuring themselves: both acutely (torn ACL) and chronically (concussions). Once they're too beat up to continue, what they earned in their career may be needed to help maintain themselves in later years. As for injuries during their career, that's usually paid by their team as an investment in returns at ticket booths and media contracts.

        When it comes to non-athletes, one should consider that physical therapy in the like can result in a return for the government by returning an injured person back into the workforce (thus the tax rolls) and so on, not to mention knock-on effect if the individual is a breadwinner.

        1. Anonymous Coward
          Anonymous Coward

          @Charles 9

          No, sports injuries have nothing to do with why top athletes get paid so well. It is gate revenue and TV money. In the days before TV, it was gate revenue. Look at what top class athletes get paid in sports that people have little interest in watching on TV or attending in person.

          Are women's professional basketball players any less likely to be injured than men's? Probably not, but they sure don't get paid millions to play like the men do. That's entirely due to the fact that no one wants to watch them on TV, and few want to attend the games. In other countries substitute football for basketball and the same is undoubtedly true (assuming there even is the rough equivalent of Premiere league for women)

      2. Yet Another Anonymous coward Silver badge

        Re: So remind me again

        >why don't we also tax those who exercise to cover physio and sports injuries too.

        Did BUPA coverage for our small company once.

        I mentioned we should be a cheap good risk, all young fit hunks.

        On the contrary we were the highest payment band the rep explained rather frankly - we have to cover expensive physio for all your rugby and skiing accidents while we dump middle aged managers with heart attacks on the NHS

      3. OzBob

        Re: So remind me again

        Sports injuries are by definition, "accidents". No-one accidentally and consistently shovels more calories into their gob than they exert.

        1. Nigel 11

          Re: So remind me again

          Sports injuries are by definition, "accidents"

          Hardly. The joint damage caused by traumas (Football, Rugby ...) or repetitive strain (Running, Tennis ...) is an entirely predictable consequence of the nature of the sports.

          And probably very expensive to the NHS, since the consequences are likely to be early onset of arthritis needing rest-of-life treatment, but not an earlier death.

          Nevertheless, I'd defend both the principle of equity, and the right to play sports (along with the right to overeat, to not play sports, to inhale tobacco smoke in private, etc. etc.)

    2. Charles 9

      Re: So remind me again

      Because anorexia and emaciation (among other things) have problems of their own separate from obesity. Furthermore, one would think the obese would purchase and consume more goods, thus they DO pay more in associated taxes.

      For some reason, Americans are VERY averse to specifically taxing vices. If foods were taxed based on its value to a healthy person, this could at least allow for some degree of correction, both in terms of reconsideration and in terms of increased revenues to handle increased catastrophic care.

      1. chivo243 Silver badge
        Coat

        Re: So remind me again

        @Charles 9

        I know that vices are pretty heavily taxed. In my home state they are called "SinTaxes" Alcohol, tobacco, Firearms and gentlemen's clubs are some that come to mind, as well as the amount of tax on petrol/benezine/gasoline. VAT varies from state to state, even counties and cities get their fingers in the till for things such as food and medicine. I know that states that have legalized Cannabis, are heavily taxing it.

        I live in a different country now, and feel no place is perfect. In the end, you trade one set of issues for another set of issues.

        I agree that health care systems should work for the patient. How that is financed is up to the beancounters in the government.

        I should stop now before the question of government and privacy comes into the argument...

        Getting my coat.

        1. Katie Saucey

          Re: So remind me again

          SinTaxes Alcohol, tobacco

          As a Canadian living a 20 minutes drive from a prosperous indian reserve, I feel lucky to be able to avoid those taxes. My carton of smokes costs me only 12$CAN, as opposed to north of 90$CAN in town, and the bottle of whiskey is about half price (though I'm pretty sure this is an illegal sale here in Ontario). That aside I'm quite sure I've already contributed enough though various ridiculous taxes and fees to fund a lung or liver replacement, should the need arise to use our great public waiting healthcare system here in the great white north.

    3. Tim Worstal

      Re: So remind me again

      Well, in a medical care system that provides life long care fat people actually save the system money. The obese (and smokers and topers) die younger and the savings from a reduced number of years of health care are greater than the treatment costs of their being fat puffing boozers.

      A strange but true fact that. And this is true purely on health care costs, without even considering any extra taxes that might be paid by various of these habits.

      1. joed

        Re: So remind me again

        I'd take a different view on this one. While it's true that the system has to provide care for healthy(ier) individual for longer, one has to consider the expense and/or complexity of the care provided to a patient with a condition resulted from obesity, smoking etc. Just to start with a simple example - did you try lifting a 400#+ blob of helpless flesh onto/off the bed?

        Also, while no politicians would mention this, every citizen is just a taxable entity. The state makes some initial investment (basic education etc) and the longer we live the greater ROI for the state (as long as we're not subject to some chronic - often obesity or smoking related - disease). In the end state always wins.

        As far as I'm concerned I agree with calling US healthcare a clusterf... And the only result of so called Obamacare is that now we're forced to fund profits of insurance companies while having no expectations of getting anything in return (especially that having spent your limited funds on the premiums you may not have noting left for egregious co-pays). Same applies to retirements funds that are great way to prop WS indexes and brokers but not a prudent way to save for an average person.

      2. Mark 85

        @Worstal - you're slightly off there.

        One of the biggest factors on the health care clustertruck that is the USA is "political correctness".

        Obesity is a "disability" thrust upon it's victims, right? Smoking is "self-inflicted". Yet, one of our former board members (health insurance company), as a doctor and an actuarial, tried repeatedly to point out that smokers should NOT be penalized. They maybe should be encouraged. They smoke, they get cancer or something equally bad and die. Money wise from the insurance company... a winner. Obese people tend to get diabetes and heart issues with drugs, surgeries, recoveries, more of the same over and over (even transplants) until they die... a money loser.

        In the offices, the smokers were constantly badgered by... the fat ones. Yet they were worst insurance risk for health care. As a smoker, I'll take my cigs and stogies and face my doom. It's far better than heart surgeries, amputations starting at toes and nibbling upwards, kidney transplants, etc. until the end.

        1. DocJames
          Pint

          Re: @Worstal - you're slightly off there.

          amputations starting at toes and nibbling upwards are usually caused by too many cigs and stogies. Just FYI.

          Non diabetic never smokers tend not to get peripheral vascular disease, and traumatic amputation is rarely progressive or age dependent.

          Much the same applies to "heart surgeries", by which I assume you mean coronary artery bypass grafting - try to guess the 2 biggest modifiable risk factors. (Alright, age is the biggest unmodifiable risk iirc.)

          And renal transplants? I'd prefer one to dialysis or death, the other options available if a transplant is offered. They tend not to get offered to the frail elderly.

          So you're basing your choices on erroneous information. They remain, however, your choices.

          (Icon: my personal choice)

    4. Naughtyhorse

      Re: So remind me again

      We do

      vat on cheesburgers

  2. Elmer Phud

    Heathcare?

    When it is a model purely to sell yet another form of insurance, other than a hearty bank account where does 'health' come in to it?

    1. Tom 7

      Re: Heathcare?

      I had a close relative who ran a $20Mpa medical business - best insurance available. Had to bring his wife back to the UK for treatment when their insurance ran out.

      1. Naughtyhorse

        Re: Heathcare?

        Had to bring his wife back to the UK for treatment when their insurance ran out.

        back taxes or fuck off :-)

  3. Charles 9

    I have one critical question about the Singapore scenario. Could what they do be realistically possible in a country that isn't a tiny little speck in Southeast Asia? Can geography snag this plan? Or perhaps cultural makeup or history (this is one thing that snags the Americans; the Red Scare has made many older Americans afraid of the S-word, and the can-do self-sufficient attitude from WW2 preceding didn't help matters. There are people who would willingly tell an infirm person, "Go somewhere and DIE" and do so with a clear moral conscience.

    1. Tim Worstal

      Good question

      And one to which there's no very good answer.

      Unless, well, what if we just accept that 2.5 million people or whatever is the right size for an efficient health care system? Meaning that one trying to voer 65 million (the NHS) or 300 million (the US) needs to be broken down into smaller and more efficient units?

      I don't say that's correct, only that it's a possible implication of Singapore being efficient just because it is a small system.

      1. Neil Barnes Silver badge

        Re: Good question

        Though if two and a half million is the right size for a health system, there's nothing to stop a country being carved up into as many chunks that size as are needful. Of course that leads to cries of 'postcode lottery' closely followed by 'well, move, then...' but in concept there's a certain amount of sense there. There's also room for competition between the blocks...

        With a smaller population to preserve, maybe you have significantly less middle management.

        But on the other hand, wasn't that the intent of the NHS Trusts that no-one, least of all the NHS, seems able to understand?

      2. John Sager

        Re: Good question

        Better to risk-pool the insurance over 60M rather than 2.5M people. The drawback there is that us healthy southerners are subsidising Glaswegians with 3rd world mortality rates, before they do croak (sorry about the Scotist stereotyping). Perhaps we just live with that for the greater good.

        1. Skoorb

          Re: Good question

          Well, sort of. You might be subsidising people in Newcastle, but the NHS is now a devolved matter, so the NHS in Scotland, Wales, NI and England are totally separate. They don't even have NHS numbers in Scotland and in NI it's all run by Social Services!

        2. Steven Jones

          Re: Good question

          @John Sager

          People dying early and quickly are actually rather subsidising everybody else. The biggest cost is the treatment of long term chronic diseases, and particularly of the elderly. It is said that type II diabetes is a problem, not so much because it kills, but because it kills very slowly but involves huge expense over time dealing with all the related chronic diseases. That's just the medical costs. Add in pensions, welfare, free bus travel, heating allowances and so on and it gets worse. The deficit is largely down to us all living longer.

          So those Glaswegians expiring early of heart attacks, lung cancer and stabbings are good value. Well, if you're an accountant (and we all know bean counters have no compassion).

        3. Fungus Bob
          Trollface

          Re: mortality rates

          "subsidising Glaswegians with 3rd world mortality rates"

          No the mortality rate is the same all over the planet - one out of every one people dies.

        4. Tim Worstal

          Re: Good question

          Could be. Although a lot of the US doesn't think so. Most large US companies are actually self-insuring. They use an insurance company to run the system but they're actually carrying the risk themselves (ie, there's no insurance fund backing up the health care payments, just company revenues). You'll note from the piece itself that I'm not exactly a fan of the US system. But as far as risk pools go 50k, 100k people seems to be large enough if companies of that size are self-insuring.

          That doesn't mean that health care provision makes sense on such a scale. You'd never be able to support the more advanced (and rare) treatments on such a scale. But as a risk pool it does seem to work for some value of "work".

      3. Ugotta B. Kiddingme

        @ Worstal - Re: Good question

        The problem with breaking any US system into smaller/efficient units is portability - both of coverage and patient.

        At one level, the US is a single jurisdiction. However, there is a second level with 50 separate jurisdictions - each with their own ideas/laws/etc. However, there are no restrictions on movement between these sub-jurisdictions. It's a simple matter for me to drive or fly to another state and my health coverage needs to work there as well. If we break down the health system into smaller units, cross-unit coverage between jurisdictions will be just as problematic as it is today between private insurers.

        Example: Outpatient Procedure X costs me $200 if I use an "in network" provider. Once my annual deductible is met, my "out of pocket" portion of that is 10%. If, however, I use an "out of network" provider either by choice or because I am across the country on vacation/assignment, that procedure now costs $500. Furthermore, because I am "out of network", my portion of that is now 30% - double whammy.

        Any designed segmentation of the US system into smaller and more efficient units must also take the above example into consideration. It could work, but must be done very carefully. Given that politicians and for-profit people will be involved, you can be certain they will get it wrong. Very VERY wrong. The ACA ("Obamacare") is a shining example of exactly HOW wrong they can be. All politics aside, the intent of the ACA was laudable, but the execution ultimately made a flawed system even worse.

      4. Tom 13

        Re: broken down into smaller and more efficient units?

        You've already cited the counter-example: Vermont

        1. John 62

          Re: broken down into smaller and more efficient units?

          1) Read the article: Vermont set up monopolies for each district, which Singapore did not.

          2) Vermont has a population one quarter the size of Singapore's.

    2. Kunari

      Even if geography and cultural issues wouldn't sink it, the special interests who are making bank-loads-of-cash would.

    3. JLV
      Thumb Up

      @Charles 9

      Nailed it!

      Not to mention that Singapore, especially while Lee Sr was at the helm, was not very democratic at all. It is however technocratic-ally competent and has low corruption ratings. Less pork, special interests and campaign contributions driving those decisions, as well as the capacity to take a hard-headed approach to health management, rather than appealing to voter fears and emotions*.

      So, aside from the small size, this is the dream type of government you'd want to design a good health care system, if they do start out with good intentions. Not entirely surprising they ended up with top tier results. And this aspect needs to be considered if you want to emulate their health care.

      This is not an endorsement of Singapore in any way, shape or form. I dislike their nanny state, morality police mentality and lack of truly competitive government. But their results in this instance brings to mind Churchill's quip about democracy as well as the philosopher king ideas of ancient Greece.

      * college buddy of mine, a doctor, was Facebooking his aversion to Obamacare by playing up the "funds for granny will be cut by Washington" card.

    4. streaky

      No it only works because it's a rich city-state with wealth based in international trade rather than actually having to work where all the kids are healthy and well educated. Give them a healthy dose of obesity and scale it up to 250 million people and it'll collapse pretty catastrophically.

  4. Efros

    Billing

    When I came to the US, about 14 years ago, the thing that struck me most with my dealings with the healthcare system is the arcane and convoluted billing system. You can and will receive bills for procedures/consultations anywhere up to a year after the event, you are also given no clues as to whether your insurance has paid this bill already or not. I also discovered that you can study for an associates degree in Medical Billing, now that fact there should tell us all something.

    1. WylieCoyoteUK

      Re: Billing

      And the bill can be changed after it has been issued.

      A few examples: (CBA to find sources at the moment, but they should be easy enough to find similar stuff)

      Guy has a few stitches after an accident, bill $200. After they find out he has insurance, bill magically triples, but is still not high enough for his insurance to pay out.

      Woman is hit by another vehicle, hers is written off,

      Hospital bill suddenly doubles when they try to claim some of her payment from the car insurance.

      1. Yet Another Anonymous coward Silver badge

        Re: Billing

        The billing inefficiency and overhead is stunning.

        I worked for an IVY league university with a fantastic insurance plan, I went for a medical at the university hospital and for the next two years received bills for $0.00, demands to pay $0.00, refunds of $0.00, statements for $0.00 and so on. A colleague broke a wrist went to the same place and received a bill for $200 because a 2nd doctor not covered by the plan had also looked at the x-ray.

    2. Anonymous Coward
      Anonymous Coward

      Re: Billing

      Had occasion to claim on travel insurance 9 months ago. Have a wonderful collection of debt collector notices received on a monthly basis ever since.(over 100 pages and growing) Tried explaining to the billers, etc that they should talk to the insurer, who accepted liability,but who was refusing to pay the outrageous bills (£8K/day for a hospital bed!). Supplied all the insurance and address info to all and sundry, rapidly came to the conclusion none of them could read and none have a email address! Now just send the bills back to whoever sent them. I can understand the insurers unwillingness to be ripped off, but 9 months for billers to not agree claims seems strange. The insurer told me that this was normal negotiating practice when dealing with US hospitals and wrote to confirm that I had no outstanding liability. The irony is that the insurer is American. The UK end of the insurance company settled my part of the claim within 4 weeks of receiving the paperwork. Having since talked to Americans, they can't understand the billing system either. I gather it's now about $15K/yr for health insurance per employee in small businesses (<100 people) with a lot of extra charges which the employee has to meet.

      1. Efros

        Re: Billing

        My insurance premium for myself and my wife with 85% coverage and a $2000 deductible is $1600 per month. That is a significant percentage of my salary and is the largest bill I pay on a monthly basis.

        1. JEDIDIAH
          Linux

          Re: Billing

          What you are complaining about is numeracy fail. Unless you are planning on milking the system, get a plan with a higher deductible. Then take the premium savings and put it into a savings a count. Put it into Health Savings Account if you can. Then not worry about how high your deductible is.

          If you don't have some sort of expensive chronic condition, there's no reason for a low deductible.

  5. Anonymous Coward
    Anonymous Coward

    THE NHS IS NOT A SINGLE ENTITY!

    It is a major mistake to consider the NHS as a single, monolithic entity. The NHS is actually comprised of the following trusts:-

    211 clinical commissioning groups (including 198 now authorised without conditions)

    160 acute trusts (including 102 foundation trusts)

    56 mental health trusts (including 41 foundation trusts)

    34 community providers (16 NHS trusts, 2 foundation trusts and 16 social enterprises)

    10 ambulance trusts (including 5 foundation trusts)

    c.8,000 GP practices (all for profit, private businesses which just bill the NHS for services rendered on a pre agreed pricing list)

    c2300 hospitals in the UK (many of which are actually their own trusts)

    So as a low figure there are 400 NHS's in the UK, all of which offer different services, operate to different standards of care (as seen in the occasional disaster which makes the news such as Mid Staffordshire) and you may be able to get certain drugs (new, and more or less experiential drugs) in the NHS in one trust, but not another. It is not for nothing that it is called a postcode lottery.

    This is because of the historical legacy of how the NHS was created, which was pretty much simply as a billing structure to pay the existing private businesses providing healthcare. Most people would consider their GP as being one of the finest parts of the NHS.

    Yet having worked in the NHS, I can tell you that as every GP practice in the country is it's own private business the NHS proper doesn't consider GP's to be part of the NHS and refuses GP's access to post jobs on the jobs.nhs.uk site etc.

    Each of the 453 trusts mentioned earlier have their own management structures, their own staff and their own IT, HR etc.

    There would be truly colossal efficiency savings to be made simply by forcing every trust within a county to use the same HR & IT staff and systems. At the moment the duplication in functions is truely staggering, and that's simply within the NHS and not accounting for the fact that the local council have their own set of staff for IT/HR staff....

    1. Chris Miller

      Re: THE NHS IS NOT A SINGLE ENTITY!

      Didn't they try the 'single IT system for the NHS' and ended up pissing away several billion before calling a halt to the clusterfuck (to borrow Tim's favourite expression)?

      1. Paul Crawford Silver badge

        Re: @Chris Miller

        You are right.

        However, the goal of a single and effective IT and management system across the NHS is a good idea, but government organisations (and a lot of private industry) seem to be useless and properly specifying and developing such a system, and the contract inevitably go to the usual suspects who seem worse at software development than a room full of 2nd year comp sci students.

        The answer? I don't know, but I guess that having a small group work with a couple of NHS trusts to prototype something, get proper feedback from those actually using it (not those who fear it, or those paying for it) and then pay more to scale & deploy it when proven would be a good start.

        1. Chris Miller
          Unhappy

          Re: @Chris Miller

          Your suggestion is extremely sensible, and therefore it will never happen.

        2. Devil's Kitchen

          Re: @Chris Miller

          There is certainly a problem in specifying software systems (traditional companies tend to think that software/UX/UI designers are nowhere as valuable as software developers), but there are other problems.

          1) Public sector organisations change their requirements a hell of a lot, and this tends to set projects back or leads to shoddy development. And, of course, whilst government "standards" are extant, trusts interpret these in different ways.

          2) There are considerable problems associated with the fact that you are dealing with people's most intimate data. The requirement for fine-grained permissions systems mean that these things are a nightmare to design, to code, to set up, and to keep efficient. Compulsory encryption means that, e.g. searching is insanely complicated (and permissions further complicate what results you can return, which also complicates pagination, etc. etc.).

          3) All of this kind of software needs to be deployed on the NHS's N3 Virtual Private Network, which is very difficult for any supplier to access, and requires "hard" point-to-point lines to any servers which are deployed on it (which very few suppliers provide)—resulting, for instance, of yearly server rental costs of £8k+ per server. Aside from the server costs, all of these measures mean that deployment and maintenance is incredibly expensive compared to a lot of software.

          4) Software security is expensive—very expensive. You generally do not want to deploy an Open Source system (the access to uncompiled code means flaws are far too easily exploited, their code review processes too lax, e.g. WordPress (constantly), Drupal's recent issue, Heartbleed SSL, and the ability to seek redress too problematic), which means proprietary systems. This means a huge investment in design and programming, but also in QA, penetration tests, URL whitelisting, measures against XSS, SQL injection, encryption algorithms, etc.

          Interestingly, however, the Scottish NHS got their version of "the Spine" up and running in about 4 years and for a few tens of millions, by using a centralised data-centre and "dumb" terminals. The NHS in England, however, did not: part of the huge expense was on replacement hardware and the setting up of the aforementioned N3 Network.

          Which merely emphasises another problem: how poor the public sector is at procurement.

          P.S. As a small company, we sometimes employ CompSci graduates: many of them can barely programme a toaster, unfortunately.

          1. Jamie Jones Silver badge
            Facepalm

            Re: @Chris Miller

            "You generally do not want to deploy an Open Source system (the access to uncompiled code means flaws are far too easily exploited, their code review processes too lax,"

            Apples and oranges.

            Your examples refer to software that is free, and used widely. That the code is exploitable is because of lax programming standards, not source visibility.

            There are many peer-tested secure open sourced projects (often paid for, but open to allow external auditing)

            How has 'security by obscurity' helped those guys and gals down at Redmond?

        3. Tom 13

          Re: across the NHS is a good idea

          Are you sure?

          There are some assumptions that go into that which I'm not sure are true. I understand there was recently a huge program to redo medical billing codes. I'm not sure if it was limited to the US, or if this was a coordinated worldwide effort. The new system is so complex it includes a code for a surfer suffering an acid burn in the ocean (okay, I hope I'm making that up but I'm told it is possible such a code exists). The new system was intended to correct a problem with the current system where unlike injuries were being thrown into the same vague billing code and throwing off calculations for what it should cost to fix a condition, (for example: broken arm, simple fracture with no complications). The end result is something that takes at least a year to learn and is actually likely to create more miscoding because they've increased the code complexity by 5 orders of magnitude. I expect this is but one of the problems you'd have in creating a system for 10 million people let alone the numbers you need for the UK or the US.

          Even your simplifying suggestion is likely to run amok as soon as you get outside the initial small group suggested. While all groups will need some similar data, most data needed by one group will be different from another. Yes, I know, that's what databases are supposed to do. But much of what they have dealt with is probably actually fairly simple compared to medical information. Which means the best approximation you'll manage is to be able to standardize within a group and then have some sort of universal data exchange to send it to another group.

          I've been told one of the Intel QC gurus was once asked if he stayed up nights worrying about how to test the billions of gates on their CPUs. He answered, "No, I worry about testing the exponentially greater combinations in which they can be triggered." I expect his issues were small compared to a universal record system for healthcare.

    2. Tom 7

      Re: THE NHS IS NOT A SINGLE ENTITY!

      But most of the diversification into different units has been done as part of the tory* 'cost savings' - ie actual increase in costs. These things are not instigated from within the NHS - even their managers couldn't think up such Machiavellian monsters if inefficiency.

      *mostly.

      1. Anonymous Coward
        Anonymous Coward

        Re: THE NHS IS NOT A SINGLE ENTITY!

        No, it wasn't. It really wasn't. I worked in the NHS while it had hundreds of trusts under the labour government, which of course brings up the biggest problem with the NHS.

        Making any changes to it is a political matter and utterly uninformed idiots will argue that it's political party X's fault, despite the problems having provably existed for 50+ years and individual trusts like mid staffs managing to kill many times more people than every serial killer in the 20th century combined.

        And people defend it anyway, despite this being utterly indefensible. And as a result of such political patronage, it's unthinkable to charge people with criminal negligence or murder when it is appropriate.

  6. Chris Miller

    Competition and choice

    A couple of years ago my brother had what turned out to be a (fortunately, relatively minor) heart attack. The ambulance was there almost before his wife put the phone down (it was a Sunday morning) and the crew correctly diagnosed the problem. "Where would you like us to take you?" was their question. He lives roughly equidistant between three hospitals. He knew absolutely nothing about how good they were at treating cardiac problems (and nor, it appears, did the ambulance crew), but getting to hospital A involved a short section of M25, visitor parking at hospital B was widely known to be terrible, so he opted for C. He was lucky, and it turned out that they'd just had a major refit of their Cardiology Dept, had all the latest kit and fixed him up a treat, but we did end up wondering what the point of patient choice was.

    1. Richard Ball

      Re: Competition and choice

      Every time I hear of Choice in the NHS I just hear Blair in Monkey Dust talking about "Education, Education, Education".

      It is tribal short-term politics and nothing more.

      1. Neil Barnes Silver badge

        Re: Competition and choice

        @Richard Ball

        A few years ago I piled into the ground in a flying accident which left me with a fine selection of broken ribs and vertebrae and sundry internal injuries; I was picked up by a helicopter (a charity I have supported generously before and especially since) and transported to hospital where I received not only the immediate care required but also subsequent emergency surgery during the recovery.

        At no time did anyone ask me where I wanted to go, or which surgeon I preferred: I was offered care, not choice, and that was exactly what I needed.

        Choice for a patient in an emergency situation should be restricted to the judgement of the physician: which hospital has the best facility vs which hospital is nearest. I shouldn't *need* to choose.

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