• Mitch Keamy Photo Mitch Keamy is an anesthesiologist in Las Vegas Nevada Andy Kofke Photo Andy Kofke is a Professor of Neuro-anesthesiology and Critical Care at the University of Pennslvania Mike O'Connor Mike O'Connor is Professor of Anesthesiology and Critical Care at the University of Chicago Rob Dean Photo Rob Dean is a cardiac anesthesiologist in Grand Rapids Michigan, with extensive experience in O.R. administration.

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The UK physician/bomber cadre adds another aspect to this matter. The NHS has maintained low barriers to entry for foreign physicians because MD compensation is so miserable in the UK; the better players come to the states or Canada, where a living wage can be had, but entry criteriae are much more restrictive. Every political unit in the world has the same problem; allocation of scarce medical resources. Some must go without some things. I am in favor of age and quality of life related allocation, i.e. no heart transplants for severe senile dementia. If this is seen as discriminatory to disabled, so be it. Now we discriminate against the near indigent (the truly indigent get medicaid) How we effectively implement allocation (RATIONING) is the problem. As long as the elderly vote and the young do not, the system will not change without governmental obfuscation of what they are really doing.

Sid Schwab

There's a problem with conflating single payor and the sort of system the British have. There's no "equal sign" between them. Having countless insurers in the US taking money out of the system while providing no actual service is getting more and more indefensible. I've been posting on it over on my blog, which is usually more devoted to what it's like to be in the OR; something about which you already know a thing or two.


this link was posted at left, right and center which bears on your post:

Sid Schwab

That's a good link: the comments are equally as important as the subject post. Thanks.

Mike O'Connor

Large organizations have enormous difficulty tracking data. Most are very good at tracking money. Even this can be more difficult than it appears at first pass, as is evidenced by the growing practice of 're-statement of earnings' in both the public and private sectors.

In theory, socialized health care can be more efficient because no participant is extracting a large percentage of the resources from the system, and smart leadership can avoid duplication of resources at every level. In practice, every socialized health care system expends an exorbitant amount on bureaucracy compared to the US healthcare system. My understanding is that there are systems in Europe that expend the majority of their resources on administration. With the NHS, it is not clear that the entirety of the cost is captured when it is calculated. Do they count the cost of training their physicians, nurses, and other medical personnel? Highly doubtful, and this is likely a major outlay. Do they count lost income from excessive wait times and avoidable death? Once again, if these numbers are correct, that cost would be staggering, and no accounting of the NHS could remotely capture its cost to the country if it was not included. It seems quite plausible that the US system, highly imperfect as it is, might be more efficient than any of its alternatives.

Flip side here? If there are really 45 million uninsured US citizens, and their wait times are on par with those in England, then there could be a body count in the US which rivals that I guestimated for England. As I stated previously, my belief is that wait times at county hospitals in the US are likely substantially better than those in the NHS, and thus our body count from wait times is likely lower.

Dr Schwab has contended that a single payor system would be different than the NHS. He is correct. That said, a highly regulated single payor system might perform identically to the NHS. All solutions are political and social in nature. Each alternative has both strengths and weaknesses. No solution might be preferable - strongly preferable over the long term - to many of the alternatives under consideration. My view? Any solution which minimizes regulation and central planning is preferable. Free and open markets, which utilize the law of supply and demand, are the most efficient way to provide health care, period.


Hi. read Krugman in Monday NYT, here's the link if you get times select



I have always been pretty happy with the health care system in the Netherlands and I think it is better than the UK system. Around 2000 we also had problems with long waiting lists, but the waiting lists have decreased by more than 90% since.

Basic explanation of the system:
Performance report:

Especially interesting is the graph at page 15 of the report on the cost effectiveness of health care internationally.

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