Queasy over health plans
- 3 Jul 08, 10:21 AM
There are the odd political moments when you know an unlovely piece of jargon is going to be the key to a story and you just have to make sure it doesn't slip out between your lips on radio or TV. But you are grown-ups, so I will say to you "prior authorisation". That is going to be the fight ahead over healthcare in the European Union.
The British government's reaction to the European Commission's health plans were distinctly sniffy in the first place. "The Government is clear that health tourism will not be funded by the NHS." They later explain by "health tourism" they mean anything not funded by the NHS. The sort of health tourism the commission is talking about is OK. Well, OK-ish.
A colleague back in London interviewed Health Minister Dawn Primarolo for my piece on the Six O'Clock News and she repeatedly and insistently said there would be no change for anyone in Britain because of the new directive. That is of course true at the moment, but will it remain true if it becomes law in its present form?
The commission wants anybody to be able to travel to another EU country, get treatment, and be reimbursed. There are two big caveats. The treatment must be available at home (so no face tucks or nose jobs) and you only get back what it costs at home.
But there is a third caveat lurking in the woodwork. "Prior authorisation." At the moment, in Britain, you have to get permission from the local health authority before you travel for healthcare, if you want to get your money back. The government is absolutely adamant this system must not change. The health minister told my colleague this was because the NHS was based on "entitlement".
But the commission says governments should only impose this condition if the new law unleashes such a huge number of patients wanting treatment abroad that it threatens to send shockwaves through the whole healthcare system. Or, as they put it, "the consequent outflow of patients due to the implementation of the directive seriously undermines, or is likely to seriously undermine, the planning and rationalisation carried out in the hospital sector".
I'm told that's not meant to be taken lightly and governments would be expected to prove their case. Moreover, it would be very difficult to prove the case from day one: there would have to be hard evidence of this "outflow" or patients first.
But hang on. The government's own press release says: "very few people choose to do this (go abroad for treatment), and there has been no significant recent increase in numbers in recent years". So they are presumably admitting that they have no case to demand "prior authorisation".
I suspect the directive will come in for a lot more nobbling before we are done.
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Can't see what the issue is. I assume everyone in europe pays into a healthcare system one way or another. In the UK, it's directly chopped of your salary, in Belgium we have a "mutualité" which extracts a pittance from my wallet evey so often, so I assume healthcare is mostly state funded. In Luxembourg similarily, it goes through the (government controlled) caisse de maladie. I can go for healthcare in either country should I need it.
If the UK government will reimburse "what it would have cost at home" there can be no abuse (in theory) and will alleviate the massively underfunded and overworked NHS staff. Then maybe then can get rid of all those useless managers, eh?
As for "prior authorisation", I just hope they'll be sensible... what are the waiting lists at the NHS again?
I doubt many Brits will want, or be able to afford a trip to Holland or Belgium (for instance) to remove kidney stones or whatever, but should at leat have the opportunity if treatment in another EU country would get them operational in a shorter lapse of time.
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Prior authorisation is merely the UK government saying they want to control the loss of funds to the cross-border health providers. These NHS funds are British tax revenues so I cannot say that I think the British Government is wrong to want to control how the money is spent!
I think my only real problem will be that Wales and Scotland get imprest monies awarded from the UK Treasury. In a way, through devolved authority, this allows them to disburse their income as they see fit and we have seen this with free hospital car parking other than England and operations and medicines that the English Hospitals will not sanction being provided in Wales and Scotland. The problem with this is that the tax revenues from 50+ million English Taxpayers are subsidising the imprest for Scotland and Wales representing at most 10 million residents.
If patients from Wales and Scotland are able to travel to other EU countries but English patients are not allowed to so on cost grounds this will futher exacerbate the current divide that is growing between Scotland, Wales and England.
The government will need to address this inequality otherwise it will be England electorate asking for a referendum on secession from the United Kingdom and wanting to reduce the monies granted to the other Kingdoms!
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If the operation is actually cheaper abroad, will the patient get to keep the difference?
Maybe to help cover their air fair and other expenses etc...
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I've just thought of a potential problem with 'prior authorisation'.
Lack of freedom of choice will naturally creep into the decision making process.
Without 'prior authorisation' I, as an individual, can freely choose where I go to get this replicated treatment.
With 'prior authorisation', there will be the usual NHS Bureacracy develop which will want to control where you go, when you go and only then decide if the cost is the same as if provided by the NHS.
Typical bureacratic nonsense but bureacracy is not confined to just the EU!
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Health care is not a service industry whatever the incumbents want us to believe. They fear competition like hell. They want to continue calling the shots which in some countries like Germany means total lack of cost control and in other countries like the UK means miserable quality.
But health care is a service and should be subject to competition within a strict regulatory framework. It's my understanding that the Commission proposal would bring a basic degree of competition to the sector which is, well, healthy.
Funny though that the UK loves competition to a degree where it just destroys jobs (like in manufacturing), but still clings to the rather socialist NHS with bizarre passion. Go figure.
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G-in-Belgium (1): The problem is that this is going to divert NHS resources to medical facilities in other countries. There are only two ways that shortfall can be made up; (i) higher taxes or (ii) NHS cuts. The first is far more likely because any NHS cuts that lead to an increase in waiting times would increase the incentives for Britons to travel to another country for healthcare knowing they could reclaim the cost from the UK government.
Those on the left should oppose this EU directive because it will take the pressure off the NHS to deliver (doctors and nurses may even recommend patients go overseas to ?take the load? off the NHS), with long-term consequences for the very survival of an institution that is almost a hallmark of British civilisation. Even those on the right who have private healthcare and would prefer not to fund NHS facilities they do not use through their taxes should oppose this directive because it breaks any link between NHS cuts and lower taxes. The most likely outcome by far of this directive is both higher taxes and a worse NHS.
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I had to cover this issue in detail myself earlier this year and I have to say I was shocked by what I found out. It sounds simple in practice but what this is in reality is EU law/the EU having an indirect say over the running of the NHS.
Things such as waiting lists, which are there for a very good reason, will be undermined - was there not that Watts case recently at the European Court of Justice, and its clear that the ECJ is of the same opinion and will support the Commission's views here because of this underlining nonsense about "EU Citizenship" (I know they talk about services but there's a clear underlying link if you ask me).
This is the sort of thing Brown really has to be seen to be taking a stand against. Its just not possible to compare the NHS in the UK to other Member States' insurance driven or partially privatised systems, and the UK must make this clear, or get ready to face the fact that the whole system could come tumbling down on itself.
I do agree with #5 though that to an extent the UK can't be pushing for free trade everywhere else and be the cheerleader for liberalisation everywhere else then expect to slam the door on healthcare so easily.
Still, there's just something not right about the EU being a central reason for eventual reform of the NHS, even if it is perhaps necessary.
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There has been an assumption running through these and previous comments that the NHS is rubbish.
I don't accept that at all.
I fear that it's a target because it is a single organisation, unlike other nations' healthcare providers.
There are unquestionably sinks in the NHS as there are high spots. I imagine that's true in all healthcare systems and I doubt that the NHS varies all that much from the western norm.
The main political thing about the NHS is the preventative side. The government has an incentive to keep the nation well, because they spend less that way.
I believe that the NHS is at the more efficient end of cost-effectiveness in the western league.
The problem is, where do you get comparative figures ? The only ones that make sense are life expectancy, infant mortality and so on.
It's difficult to know how much the healthcare system as opposed to other infrastructure options and geography, etc. has a bearing on these measures - although obviously it does.
The point is that, as others have said, this is a sovereign national decision being eaten away by the EU.
The calls for a 'free market' miss the social point and the calls for social equality miss the free market point.
The EU does not care about either consideration, it simply wants to apply its will to what should be a UK decision.
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Gruenebaum1 @ #5
The problem is the history behind the rise of the NHS.
William Shirer in his book "The Rise and Fall of the Third Reich" mentions that circa 1938 he was able to compare the health of the young British to the healthier German youth and there was no comparison.
The British were round shouldered, went into work at 14 on leaving school often into mill or collier jobs which gave them ill health and if they were able to join the army, their unfitness was self-evident.
Clearly this was not good for the health of the nation and so the dream of the NHS came into being. It was postponed because of WWII but in 1948 the NHS was launched.
There was much consternation amongst the Doctors but generally speaking it was a good launch and the intention was good. In the ealry 20th Centrury the NHS was fit for purpose and met the needs of the UK population.
However, it has now become a sacred cow and the NHS simply holds all successive UK governemts to ransom - demanding more and more money to be injected into what has become a bottomless pit.
Now we are in the 21st Century, we find the NHS has become a bureaucratic juggernaut and it is stumbling under the weight of demand, supply and cost issues.
It would take a very strong UK Leader to even broach the subject chnaging let alone dismantling the NHS and restarting it so that it was fit to meet the needs of the 21st Century and - as Mark alluded to the Conservative Party dillema over the EU in an ealrier Blog Posting - strong UK leaders do not become Party Leaders these days!
T'is very vexxing indeed!
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Austrian Radio website reports that there are internet restriction that the British government is unable to get through the UK parliament so it has tried to get them in through the "EU" and that this is a well-trodden path. I do not want this country to be governed by the peoples who gave the world Marxism, Fascism, the Inquisition and the Mafia. I do not want opaque government. I want to know who is responsible for what so I can vote accordingly.
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FreebornJohn ¤6
The evidence from many different sectors and from across the world is that competiton leads to greater efficiencies and improved service - the alternative being to go out of business.
Since the NHS won't be allowed to go out of business - will it (????) - then efficiencies, etc would have to be achieved.
From my limited knowledge of what's happening to the NHS in the UK, I thought that they, and private hospitals were supposed to "bid" for work from more local Health Authorities? If this is the case, then - as happens with duopolies - there is a likelihood of price "agreements" (illegal but hard to prove).
Anyway, at present I'm happy with the French system - a mix of private and national care, paid for partly by the State insurance scheme and private insurance (not expensive). So I can't see myself using the NHS yet (tho, of course I have my E whatever it is card).
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Good points Freeborn-John(6).
On the other hand, moving certain patients abroad would save money on plenty of things. I can't remember all of the details my dear sis in law has voiced, but humongous waste was definitely among them (several times). Less waste = money saved. It could be an excuse to restructure the NHS as several contributors to this thread deem necessary.
Having witnessed first-hand healthcare on the continent, I would definitely compare it with the UK's private service and public cost.
The NHS appears to be run on similar lines to British Leyland. At least it makes suffolk-boy happy :P
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I think the NHS does somethings well but could improve. However I do not want to get into that argument, what is important to me is that it is nothing what so ever to do with the E.U. as to what services we provide and more importantly where.
I want the British Government to decide that. I can try and vote them out at the next election if I am not happy. I cannot do that with the E.U. - The Health service of each country should be the sole preserve of the people of that country as to what happens to it. Not the E.U. or it's courts or any commisioner etc etc
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Frenchderek (11): I believe in free markets for the reason you identify, namely that the invisible hand of the market seems to be the best guide to providing goods and services as efficiently as possible. However even the most efficient market will settle on a price for a product or service below which that good will not be supplied. If the consequences of not providing a service to those in need of it (e.g. the education of children or the care of the sick) cannot be tolerated by a civilised society then it becomes a legitimate role of the state to step in and do what the free market is not willing to do. Other countries may have more minimalist answers to this dilemma in healthcare than the UK, but I am happy that we have the NHS. I don't think any political party could win power in this country if they were seen to be threatening the NHS, and I don?t see why ECJ judges or unelected EU Commissioners should be able to do what the British electorate would not allow our elected politicians to get away with.
You point out that there has been an 'internal market' within the NHS for some time, but that is something very different from an external market that would cherry-pick the most profitable NHS 'customers'. If this EU directive goes ahead the NHS will still be needed for those who cannot afford the travel and reimbursable advance-payment for treatment in other EU countries, and for those with conditions that hospitals in other countries cannot make a business case for handling. The EU queue jumpers will likely join those with private health care who denigrate a national health service essential to others, but which they do not use and would therefore prefer not to support through their taxes. I do not think the NHS would ever 'go out of business', but should there ever be a majority of the British electorate that do not use it, the NHS could easily spiral downwards into the kind of sink healthcare provider of last resort that we see elsewhere in the western world.
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jordanbasset @ #13
I wholeheartedly agree that control of the NHS must remain a UK sovereign area of responsibility.
However, apart from the social inequity of only the UK's well off or privately insured citizens being able to fund their travel and treatment - up front - for across-the-border health care, I actually concur with the intent of this EU legislation.
Oh, and of course, "prior authorisation", will simply mean that the people who can afford across-the-border treatment will never get that authorisation.
The strange thing is that the ECJ ruling means they CAN get their money refunded regardless of this legislation AND do so without "prior authorisation". I'm not sure what else the UK might want to nobble but I think thay may find themselves unable to ensure "prior authorisation" is upheld?
I think the UK Government will have bow to the EJC rulings and accept the legislation without the "prior authorisation" codicil.
But it is all very vexxing!
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Frenchderek and G-in-Belgium: I have lived on the Continent (Germany) too and so had some limited experience of that country's healthcare system. I am sure the German healthcare is good, but I did feel there was a lack of what in the UK are called GPs (General Practitioners). I really had to diagnose myself, only to go along to a kidney specialist who told me there was nothing wrong with my kidneys and left me to hobble out 100 DM lighter wondering what kind of specialist to see next. However it may only be in Germany where every doctor feels a need to be a specialist.
I have no 1st hand experience of the French healthcare system. However when travelling in Asia a few years ago I shared a train compartment with two young Vietnamese. The guy worked for a French motor manufacturer in Saigon and had been based in France during the 1998 World Cup, an event which his employer was sponsoring. He had access to tickets through work and the girl (his sister) visited him in Paris during the tournament also taking the opportunity to have some laser eye surgery performed. Unfortunately the French doctor operated on the wrong eye, leaving her unable to read from either eye. She later had to abandon her studies at Saigon University. The French doctor offered her $100 compensation. Of course very few health tourists will have problems, but it is clear that the risk of something going wrong will be greater in a country where they speak a different language and it will be harder to correct any problems at long distance once they have arisen. I think most people will prefer to go to a local doctor who knows their case and speaks the same language. But perhaps the EU Commission feel a few such mishaps would be a small price to pay if it leads to them acquiring more power?
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@suffolkboy2 (10)
this is no surprise. The system was deliberately set up the way it is to encourage government ministers to take their plans to Brussels and get them approved via that route. Because via Brussels, the EU politburo (commission) and council combined can legislate to their hearts content and not have to bother with the will of any parliament. As I have argued many times, this is why I keep saying that parliamentary democracy is dead, parliaments have no legislative supremacy anymore that has now been given to the EU politburo.
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A lot of Brits posting here and the original blog itself seem to think that given a choice, a lot of Brits will opt to go abroad for their medical treatment because it is better elsewhere, say France where half the national GDP is spent on medical care. This is hardly a vote of confidence in the NHS. However there is another possiblity and that is that people from other countries where waiting lists are longer and care even worse will flood into Britain further overtaxing its already overtaxed system.
So let's say your are from one EU country, Britain and you take a train to Paris and report to a doctor or hospital and say you are sick. What are they going to do, send you home to wait for authorization?
The new system will pose an interesting problem for those trying to plan national health care capacity. How do you judge if you have provided a system that has too much capacity or too little? And it opens up a whole new industry, medical tour guides who will advise you how to shop and where to go for the best deals. And oh yes, how to work the system to your own best advantage. Makes you wonder if those at the top of NHS don't wish there was a referendum to get out of this mess.
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In my case a hospital in Berlin took three hour to find out what my local hospital in the UK failed to find out in five and one half years. It is fantastic. A man told me that he couldn't afford to go private. My argument is that I could not afford not to. Because of German health care I can now work again.
There is a lot of talk about Germans being arrogant. When it comes from to religion, family and politics, especially the "EU", I have seen a lot of arrogance and dictatorship in Germany. When it comes to doctors, I have seen none. I have seen a fair amount of arrogance from doctors in the NHS.
My experience is that Germans are incredibly kind when you are ill and that they put the Brits to shame - doctors and non-doctors.
In the hospital I visited in Berlin the specialist spoke very good English. So if you are up the creek - go German! Go on! Email them and ask! Try www.ukb.de
In the UK you might not even know that what you have is curable. They might tell you that there is no treatment and no therapy as I was told.
However, the statistics I have seen indicate that Swiss health care is even better.
So we don't have to be in the "EU" to have better health care. We just have to copy these other countries.
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By the time people have to go to a hospital....they can't wait 15 days. What happens if the bureaucracy fails to respond within 15 days because it is also overtaxed? Do you get automatic approval? I'll bet NHS says no to that idea. So how lond do you wait? 30 days? 60 days? Who will be the first to sue the NHS in the European Court over their failure to comply with that regulation?
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I would be a bit QUEASY about this type of issues that Brussels wants to take control from the National government.
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dennisjunior1
Why just this one? They are taking control over EVERY issue away from the constituent governments. That's the whole idea behind the EU superstate. Wake up and smell the coffee.
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We've learnt a lot about cuisine and cafe society from the Continent. We can learn a lot about healthcare too.
Our NHS is the healthcare equivalent of 1950s British cooking. It's long past its 'use by' date.
(It's amusing that this is a subject upon which EUrosceptics like SuffolkBoy2 and me can agree with arch-EUrophiles like Gruenebaum1)
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To #19,
I dunno, I heard from a Greek friend that he had a relative who went to Germany to get treatment for something.
When one of his other relatives who was accompanying them was asked by the doctor something in German, and they had to inform them that they couldn't speak German, apparently the Doctor then went "then why are you here in this country?" and was very rude.
So I think its all very subjective, but I wouldn't be surprised if the level of rudeness over there amongst staff is the same as it is over here.
As it is, the NHS staff up here in Scotland do tend to be friendly and I've never heard of any bad stories up here on that issue!
Waiting lists, well, thats another story. Thats the thing, the NHS is in a rut in England, but its even worse in Scotland despite the fact that we pour more money into it up here. Its like a black hole.
I stand by what I said though, using the Commission and the EU to push for reform of our NHS, or even allowing the Commission to force the issue itself, is just unacceptable. This issue was known about, and was on the horizon prior to the Lisbon Treaty negotiations and some sort of exception should have been put in for us, as it would have, and has been in the past for other member states (ie. the Dutch, the French, "public service obligations" etc etc). But alas Blair thought he'd leave us a leaving present in pretty much doing one of the worst negotiating job probably in the history of these IGCs by a UK Prime Minister.
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MarcusAureliusII
In describing the American health care system, you have said the system for paying for it is broken. But if the system for paying for you health care is broken, then how can it survive?
I do not support the proposed new directive that would allow health tourism and trust the Govt will do all that it can to block it.
At best it will only help rich British people who can afford to travel and who could just as easily afford to go private in the UK. At worst it could lead to health tourism from other poorer parts of the EU coming to Britain and reducing the level of health care available for our own citizens from the NHS.
There is therefore nothing in this proposal to help ordinary citizens and it could do immense harm to the NHS.
The proposed directive is yet another example of the EU seeking to take power from member states by imposing duties on them in a dictatorial way and contrary to the democratic wishes of member states and their electorates. Our Govt should tell the Commission to get stuffed in the most direct manner possible!
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Frankly, I find it rather disheartening that the reaction of many contributors is "well, it may seem like a good idea, but OH GOD IT'S ANOTHER DASTARDLY BRUSSELS PLOT TO TAKE AWAY OUR SOVEREIGNITY! We must keep our right to wait for years for an operation!". Especially as the refunds will only be up to the amount that the treatment would cost at home, so that I don't see how this would drain "resources" (unless you see patients as resources) from the NHS. Considering furthermore that the NHS has trouble coping with demand, and must hire medical and paramedical staff from all around the place, it seems more logical to move some patients abroad than to keep importing doctors and nurses...
Anyway, what many contributors (both pro and against) are failing to consider is that very few people, when confronted with serious illness, will actually prefer to move abroad for treatment. There are many reasons (proximity from family and friends, additional stress) why most people will rather compromise and stay at home. However, this directive would certainly make things a lot easier for tourists and expats who have the misfortune of falling ill while abroad.
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RCalvo (26): Tourists have travel insurance. Expats are covered by either the taxes they pay, or their employer?s health care scheme.
You seem to be suggesting that no-one (or hardly anyone) will benefit from this proposed directive, so one should indeed question why it is being introduced in the first place. The true answer is that real-world problem solving is not the reason the EU Commission proposes directives. This partly explains why so much of what they actually do is of such poor quality. They really are not bothered at all what the policy outcomes are. They only ever propose new laws that lead to the Brussels institutions acquiring more powers. Not once in their 50-year history has the EU Commission ever proposed to return a power previously acquired by them back to the democratic arena of the nation-state, even when this would (as in the case of the CAP) make obvious sense. The Commission?s monopoly on legislative initiative means that even all 27 elected governments acting together cannot make them do so. The Commision would dearly love to establish an equivalent of the CAP in healthcare, a sector that consumes around 10% of GDP. It is better to nip their ambitions in the bud, especially when their pretext for this directive is so weak.
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"Freeborn"-John (27): Not all tourists have travel insurance. Nor are all expats (in particular those on temporary displacement) covered. And why should you be obliged to buy insurance for something you are supposedly already covered against by your social security/NHS contribution or taxes?!
The EU has been involved in harmonising healthcare provisions since a long, long time. I've been living abroad for long enough to know and be thankful for it. According to Mr. Mardell's posting, the only thing this directive would change is eliminating the "prior authorisation" requirement, which sounds like A Very Good Thing, since illnesses rarely ask for "prior authorisation", and would *remove* a bureaucratic layer.
Please make your case on the merits of the directive, and not on your perception of the Commission.
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Many of the comments as to why people don't like this idea seem to be related to the "uniqueness" of the NHS compared to other European healthcare systems. In fact, the NHS is not as unique as we might like to think: only France, Belgium, Luxembourg and (to an extent) Germany actually require people to pay upfront and be reimbursed for their healthcare. Most, like the UK, keep payments between professionals, and several countries even have a specifically NHS-style system (Spain, Italy, and the Nordics) modelled on the UK. The NHS is quite segmented internally and there's no reason I can see why sending someone from Newcastle for specialist treatment in Germany should be any different administratively to sending them to London.
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RCalvo (28): I do not see any reason why states should provide free travel insurance for their citizens. Still less reason why such state-funded travel insurance should only be available to those that holiday in another member of the European Union. And ex-pats are by definition people working in another country than their native one, where they pay local taxes that make them eligible for the local healthcare those taxes pay for.
I am not sure what directive you think you are talking about, but the one under discussion here has nothing to do with holidaymakers or ex-pat workers. It is about normal citizens who live in their own country being able to go to another country for healthcare and to be refunded the costs of that healthcare by their own state (if it has pre-authorised the treatment). Nobody has asked the EU to interfere here at all and it has no mandate to do so. The unelected politicians in a black robes that sit on the ECJ should not be able to mandate significant new areas of public spending such as state-funded health tourism.
http://news.bbc.co.uk/2/hi/europe/7486151.stm
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I would be interested to know if other countries have the equivalent of prescription charges or whether medicines have to be paid for as an additional cost to treatment?
It would then be of interest to know whether the inequities of the UK NHS (now having 4 Health Ministers and 4 different ways that the the 3 countries and 1 province NHS Services are run) would allow for one person (from Wales and soon from Scotland and NI) to be able to claim their medicine fees back whereas another (from England) would not be able to do so?
I know that on one occasion in Greece I had tooth abcess develop and went to a doctor. The Doctor prescribed the dental penicillin (amoxycillin in the UK). The cost was (as I recall) approximately 20 Euros for the medical appointment and about 35 Euros for the medicines.
Now I presume, under this EU legislation, that I would have been able to claim the costs back from the NHS but my question would be - is the re-imbursement just for the medical examination or would it also include re-imbursement for the cost of medicines dispensed?
If it were both costs then the new EU legislation would cast a bright spotlight on the inequity of Welsh and (soon Northern Irish and Scotish) patients being able to claim back prescription charges whilst the English would not!
I wonder how the Scottish run English/UK parliament would get out of that discrepancy and obvious inequity?
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In the long term I believe integration within the EU health sector should be promoted. If there are economies of scale that can be exploited, then we should exploit them. If an EU procurement service can negotiate better drug and equipment prices, then we should create it.
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"Freeborn"-John: The thing is, nobody is asking for an additional "travel insurance", only to be able to request the very same payment if you are treated abroad than if you are treated at home. Why "only" in the EU? Well, because we have it. One of the main points of the EU is to provide freedom of movement, remember? If it was possible to extend this to non-EU countries, then even better.
Are expats necessarily covered by the national health system of their country of residence? Well, not necessarily. Students aren't (they must go through the whole E-Something-Or-Other formular hassle), nor are those who work a few months in one country, but have their employment contract in another. Then there's the people who live in one country and work across the border (quite common in Continental border regions) Those may seem small groups to you, but they sum up to quite a significant number of people, and the consequences of illness can be quite dramatic for them.
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"Freeborn"-John @ 30: Besides students and working expats, another very significant group which is currently less than secure in their health coverage are pensioners abroad (including, BTW, quite a significant number of Britons in my country). Their healthcare remains in principle the responsability of the country where they worked.
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Busby2 #25
How does the American health care system survive? Through a crazy quilt patchwork of private insurance, Medicare, Medicaid, higher taxes, higher insurance premiums, and people's life savings being drained if they have no insurance but do have assets. When hospitals deteriorate to the point where they do not meet the minimal accepted standards, steps are taken until it is clear they can't and then they are forced to close. Substandard health care is not allowed because it opens up the provider to enormous litigation liability for medical malpractice. There can even be criminal penalties if the negilgence should have been anticipated and resulted in injury or death. It also makes those who have a choice go elsewhere because word spreads quickly. Lawsuits are very common in the US and lawyers who specialize in medical malpractice cases are called ambulance chasers. It's hard for me to believe but somewhere I read that in our nation of about 300 million people, we have 2 million lawyers. I can't believe it is that high but America is by far the most litigious nation in the world. People sue seemingly for anything. We'd like to devise a better system but so far, nobody has come up with a plan that looks like it will work, is fair, and will not compromise the quality of service we demand. Hillary Clinton's plan was horrible and not acceptable. We are not going to sacrifice our stanards for the middle and upper class to be certain that both the poor and middle class unemployed somehow get insurance. They get treatment anyway right now. Remarkably, even in Canada which should have standards comparable to America's, people go to the US at times for medical treatment. I don't know if it's a quality issue or a waiting list issue. BTW, when someone who does not speak English is ill or in trouble, we find people who speak their language and can translate for them. We don't turn them away and we don't tell them to go find another country as SCNFL29 in #24 reported. Recently the pharmaceutical companies have been making drugs available at reduced or no cost to those who need them but can't afford them. We give them away to foreign countries, it's the least we can do for our own people.
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Freeborn-John (post 30)
Excellent post Freeborn_John!
You hit the nail on the head when you wrote "Nobody has asked the EU to interfere here at all and it has no mandate to do so. The unelected politicians and judges in black robes that sit on the ECJ should not be able to mandate significant new areas of public spending such as state-funded health tourism".
This proposal sums up what is wrong with the EU. Here we have a bunch of unelected and unaccountable civil servants in the Commission drafting a directive that will supercede national laws that nobody has asked for. In a democratic state, the civil servants drafting legislation do so on the instructions of their democratically elected politicians. But this is not so in the dictatorial and undemocratic EU.
Whether or not the proposal will be amended by ministers is a matter of conjecture but one thing is clear: the ministers are on the back foot here instead of being in charge as they would be in a democratic set up. And when the proposal eventually reaches the European Parliament, they have only the option of approving the directive or rejecting it entirley. They cannot amend a directive of the Commission.
Power lies with the unelected commission. Nothing happens without their approval. They dictate the agenda and none of their proposals can ever be amended by the European Parliament.
It is not so much that member states have given up or pooled sovereignty by joining the EU. They have in fact given up their sovereignty in large part to the unelected and unaccountable civil servants in the Commission. Democratic accountability at home and in the EU has been dispensed with.
I envy Americans, Canadians and Australians who live in democratic countries which can truly hold their legislature to account for their actions. Our ability to do that started to disappear when we joined the EEC and has continued ever since.
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To UK, US and others not having experience of mainland European healthcare.
My experience of German health care was that it was excellent - but riddled with bureaucracy and, at the individual doctor/consultant level, was subject to some strange discriminations (eg the consultant, fluent in English, insisted in talking in German only during the medical bits of the consultation - when it was a critical case!).
My experience in France is that the service is almost unbelievable after the UK. eg "When would you like your appointment?"; a blood-test clinic that looks like a 4* hotel lobby; "would you like a single/shared room?" at the hospital. Yes, I pay the GP ?22 at each visit but my Carte Vitale (state scheme registration card) sees a refund of ?20 into my bank and then a refund of the other ?2 from my insurers. For those below a certain earnings level their carte vitale ensures no payment (ie the poorest get the same treatment at no cost. I also realise that things may be different in the big cities; that the system has many flaws; and that is over-expensive to the state (ie tax-payers like me - but it's still good.
As I said on Mark's previous posting about this EU health proposal, it is up to the state to decide what level of insurance it provides its citizens, and up to them (as insurers) to set conditions on how health care may be obtained - from wherever their citizene get it.
To those who see this as 'another case of EU domination':
The EU is a complement to the member nation states. Under current provisions (ie the Nice Teaty) most proposed legislation can be "shot down" or at least undermined by any single government, if it so wishes. Once the legislation is agreed, then the EU has a monitoring/policing role (but that is as agreed through various treaties).
My understanding is that the UK has been party to the negotiations over this health legislation (and has fought its corner hard). Address your complaints to your own government.
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frenchderek @ #37
Oddly enough, I actually agree that this is one piece of EU driven legislation that could be a good example of closer European co-operation - merely because the driving force was an British Woman challenging the ECJ to confirm her right to universal healthcare given that she had freedom to travel within Western Europe.
The problem for the UK is that all of our major political parties are basically held to ransom by the existing NHS (regardless whether one feels it is a good service or a poor NHS!). To change it would need a Dictator to be given power in the UK!
Now, I'm not saying that I support the EU to interfere, I am merely suggesting that Health is one common factor among all peoples and the right to seek treatment where you fall ill does seem an area of common ground that all people could agree to. Indeed, if this were driven by Governments around the world and became a global benefit it would still seem like a reasonably good idea to me.
To travel to receive treatment paid for up front does seem odd but that was the ECJ court case and so they seem to feel it is a right to be enjoyed by all Europeans. I tend to think that it would mean that travellers, ex-patriots working in other countries and other could benefit from the sharing of resoucres and enjoy the economies of scale (unfotunately the proviso that the treatment must be available in the home country does seem to kill that economic benefit off!).
However, if the UK insist on the "prior authorisation" the UK citizens living elsewhere than the UK are going to get stuffed!
The more I think about it the less I like the idea of "prior authorisation".
Just maybe, this is an area of closer European co-operation that I can accept even though it stems from the EU.
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RCalvo (33/34): This directive does not (and is not intended to) address any of the cases you are talking about. The weird and wonderful scenarios of people living in one country and working in another (but not paying taxes there!) are the usual wild arguments of last resort trotted out by federalists to justify the expansion of EU power over the 99.99999% of people who do no such thing. But for once you can leave that argument in the bottom of the barrel where it belongs because this directive is aimed at those who live and work in their native country but want to visit another country specifically for the purpose of receiving healthcare, and to be compensated for that treatment at state expense.
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Freeborn-John @30:
You are confusing TRAVEL insurance (always a private matter covering such things as lost luggage, credit cards, emergency flights home and even repatriation of a vehicle) with HEALTH insurance. Surely, it makes sense that a group of neighbouring countries make reciprocal arrangements to enable their citizens to obtain medical treatment in each other's territories without extra charge? The UK scheme actually extends way beyond the EU anyway.
If we did not do this, the chronically sick and elderley who could not get such insurance privately would become prisoners within their own countries.
Ex-pats do not necessarily work abroad, they may have retired in another state, as is their right to do. After paying UK tax all thier lives does he think it right that they should be denied the right to free medical treatment in their chosen home?
There are also cross-border commuters who live in one state and work in another - a group often forgotten by Britons who cannot get over their little-island mentality (most of whom are also oblivious to the fact that the UK does actually have a land border, let alone the existence of commuters who use Eurostar and the Chunnel). Do they not have a right to medical treatment at home as well as at work?
Some people are still stuck in their little national/tribal "sovereign" territories, unable to grasp that mass transport and communications are moving the world on and breaking down borders. While much of Europe and the world is moving into the 21st Century, much of Britain is still evidently stuck in the 19th.
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to busby2 @36
So you envy the many Americans who cannot afford health care insurance either because they are too poor or too sick, and cannot get jobs that provide cover?
So you envy a system that costs American business so much to provide healthcare insurance for its current and past employees just to fund a bloated and overpaid elite of doctors and hospitals that once great and profitable businesses like General Motors are being brought to their knees, while Toyota and Honda can afford to invest for the future and will soon overtake them?
So you envy a world where the middle class are terrified of being sick because profit motivated and unregulated insurers wriggle and squirm rather than paying out for the treatment their policyholders require?
The NHS is far from perfect, and in fact many European regulated insuance based sytsems are better than the NHS - they represent the way the UK should be going - but ALL the western European systems are streets ahead of the US in terms of healthcare.
The US healthcare system is not a good advert for their democracy.
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MarcusAureliusII
Thank you for your informative reply at 35.
I expect that there were many here in the UK in 1948, when the NHS was founded, who would have agreed with your comment "We'd like to devise a better system but so far, nobody has come up with a plan that looks like it will work, is fair, and will not compromise the quality of service we demand".
Many doctors opposed the start of the NHS and they were given the right to share their time between private and NHS patients. I benefitted from this myself when I was treated as an NHS patient in a London teaching hospital by a top consultant who shared his time between his private Harley Street practice and working for the NHS.
The advantage of our system is that private health care is available if you wish to pay for it but health care under the NHS is available to all citizens at no additional cost at the point of delivery.
My suggested solution to the health care system in the USA would be to adopt a similar system. This should preserve the standards you hold so dear and at the same time extend health care to all that covers both emergency and continuing treatment for conditions that are not necessarily life threatening.
Cost is of course the big issue. However when you consider that Americans are already paying far more for health care than anyone else, and that these costs are becoming prohibitive for more and more Americans every year, something has to be done!
A state funded health care out of general taxation should not be seen as socialist, as you consider that to be a dirty word, but more as a Christian duty.
You also helpfully raised the issue of Americans being the most litigious nation on earth. I believe I'm right in saying that this has greatly increased health costs as all doctors have to pay very high premiums which then have to be recoved in fees from patients. This in itself provides a further incentive to sue doctors even if no real harm was done. Doctors also try to cover themselves from being sued by authorising more and more tests on patients than strictly necessary, which also increases costs substantially for patients.
Perhaps the answer to the litigious problem in the USA has to be legislation which gives doctors much more protection except in cases of gross negligence and incompetance.
SuperJulianR (post 41)
Your reply illustrates more of the problems of the US health system which we don't suffer from in the UK.
The US health system is entirely of their own making. If the democratic will is there, the system will be reformed and a health care system that gives health cover to all would be set up. However much as Americans may see the problems they face, I'm not sure that there is any political will to reform the system. And so the situation deteriorates.
The most important part of democracy is to make your own decisions as a society, to be responsible for those decisions and to have the ability to change those decisions without reference to some foreign, unaccountable and undemocratic body.
This proposed EU directive is another example of removing democratic accountability. If we wished as a nation to give our citizens the right to recover the costs of operations undertaken abroad, then that should be the decision of the UK Parliament and the UK Parliament alone. And in reaching that decision, the Govt should pay due regard to the cost and public acceptability, knowing that they are accountable to the electorate at the next General Election for the discharge of their duites.
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France the new health consumer champion! The Euro Health Consumer Index 2006 points out to the most consumer-friendly health care system in the European union, as rated by 27 Index indicators. The 2006 Index includes all the 25 EU public healthcare systems plus Switzerland for reference. France emerges as the 2006 winner of the Euro Health Consumer Index, "with a technically efficient and generously providing healthcare system". France scores 576 out of 750 maximum points. 2005 years winner, the Netherlands, now takes the silver position, followed by Germany. Estonia and Slovakia gets the highest ranking in the category "value for money". Taking a strong consumer view, the 2006 Euro Health Consumer Index wants to add to already existing evaluations by institutions like WHO and OECD. Introducing a different perspective, our Index ranks how user-friendly the national healthcare turns out around the Union. Our Index is to be annually updated and developed, reflecting the expansion of the EU membership. Analysing the position of the consumer as shown by the 2006 Index, we find for example that: - Only four EU countries out of 25 offer some kind of provider catalogue (just one with a quality ranking). - Three out of four national systems cannot treat your cancer within three weeks. - In only one out of three you have direct access to a medical specialist. - The same goes for the right to a second opinion. - Every second country blocks the patient´s access to her own medical record. - Two out of three governments delays the introduction of new pharmaceuticals into the reimbursement system. To see the full results: [Unsuitable/Broken URL removed by Moderator]
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busby2 @ #42
This must be some evil plot by the EU to divide the EUsceptic Europeans!
I started of with my first comment in this thread thinking that it was right that the UK Government retain cost control over the NHS by (a) retaining sovereign authority over Health matters and (b) by using the "prior authorization" control they could effectively control NHS expenditure.
I have actually come around, after reading some of the comments and thinking it through, to believing that "prior authorisation" may be a 'nobble (as mark puts it) too far.
Firstly, because no UK government (be it Tory or Labour) will change the NHS, we have got we have - a sacred cow that swallows money without the public actually feeling that things are really improving. Oh, yes - waiting times are down (but not in Scotland), prescriptions are free (but only in Wales) and so much of the Blair Government £600 million additional investment inot the NHS has just disappeared! A lot of the "Labour Government improvements during their years in office" are merely smoke and mirror deceptions.
The problem is, because the NHS is such a sacred cow even the new Conservative Government (I am counting the days and minutes now!) will not have the courage to truly revamp the NHS and make it fit for the 21st Century.
Thus, even if WE think that the UK Governement is best placed, for democratic reasons alone, to be the managers of the NHS I am a bit concerned that any UK Governemt can actually (and in real terms) make much change to the NHS Behemoth.
Sometimes a kick like the EU Legislative Cross-border Healthcare proposals could be a good thing - both for driving changes in NHS attitudes and protectionism AND give the UK Government an excuse to push through some radical changes to the NHS that are long overdue.
Of course, any such changes must be proposed, planned and implemented through Parliament but sometime an external initiative can be a good thing to give Parliament a nudge in the right direction!
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Menedemus
I would be interested to hear what changes you would like to make to the NHS to make it fit for the 21st century, as you put it in your posting.
Of course we must always be open to see how other nations handle their health systems to see if there is anthing we can learn from them to improve our own.
But in this case, the EU are proposing to impose health tourism on all member states which will not bring any benefits, except to the mobile rich. Most of us won't have such a choice. It would impose additional bureaucratic costs and reduce health care for those living here. After all it will also be open to EU foreigners to come here and although I suppose we will be able to charge them, I am not at all convinced that any revenue received will not be used to boost NHS budgets to treat British patients. At the same time we will spend large sums of money accounting for all these costs, both for those who come here and for those who go abroad. Once again I fear this will be lost money to the NHS as, unless I'm very much mistaken, any money received will not go back into NHS budgets. I suspect that the Treasury will probably take the receipts leaving individual trusts out of pocket.
Those who can take advantage of going abroad for treatment are surely those who could just as easily choose to go private here in the UK. It must be their choice whether to go private here in the UK or go private abroad. Why on earth should the British taxpayer pick up part of the bill? And who is to pay for the bureaucratic cost of working out and billing the patient?
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busby2
There are no free lunches. One way or another, society as a whole has to pay for what it gets. Doctors and nurses will not go to the trouble to achieve the highest levels their professions are capable of if they are not well paid for their services. Nobody is going to build a community a hospital or provide it with equipment unless there is a profit in it. In a socialist system where private profit is not allowed and the government monopolizes the market restricting what you can earn, the system collapses into disrepair, failed, inadequate, or non existant service. Socialists try to hide this but just look at what the USSR offered its population in the way of medical care. Nor did their socialist system offer up any advancements to the state of the art of medical science in over 70 years.
One type of medical coverage in the US is called an HMO or Health Maintenance Organization. This type of insurance requires you to use doctors and hospitals within the system except in an emergency. They work for agreed to fees for their services. An unintended loophole in the law allowed them to be exempt from malpractice lawsuits. This resulted in them bringing over incompetent doctors from around the world who gave inferior treatment and were paid low salaries. If they didn't cooperate with their employers, they were shipped back to Timbuktu. As medical care it was the kiss of death. I think that's been fixed now. There is a battle raging between the doctors and lawyers over legal liability for medical malpractice. It's part of a larger war over limits of awards for damage under our tort law system. It goes under the code name of tort law liability reform. What it is, is a way to limit the damages someone such as a business or doctor has to pay for the injury, damage, and suffering they have caused through their negligence and incompetence. So far the lawyers are winning. Heaven help us if they don't.
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busby2 @ #45
My baby grandaughter was born on 27th January 2008 in a maternity wing of a hospital 'somewhere in the midlands'.
The nursing care was wonderful.
My daughter and her husband became the proud parents of a healthy baby girl born full-term with no complications.
My wife and I travelled from our home (somewherein East Anglia) to be there for and after the birth.
The one thing that stood out a mile that made me think that the NHS is not keeping pace with the onward march of time was the fabric and state of the Maternity Wing.
It was derelict in appearance, paint was peeling from the walls, there were broken windows that had not been repaired and the overall impression was that the building was and had been severely neglected and had not been refurbished for years and probably decades.
My own experience of both private insurance healthcare paractices and NHS practices is one of tiered-referral within the NHS.
I am over 40+and suffer a common age related ailment called sub-acromial impingement in my left shoulder joint.
With private treatment I was referred to a consultant > received physiotherapy > revisited the consultant and was given two steroid injections. This is typical standard treatment for the condition and the symtoms disappeared after about 4 months from onset.
8 years later I had the same ailment reoccur and was reffered to a consultant > saw a Physiotherapist > then saw a Medical Physiotherapist > had more physio therapy. I finally saw the cConsultant who diagnosed the original ailment, gave me an injection. I am now patiently hoping that the pain from my ailment will subside as quickly as it did 8 years previously. It is now * months since onset of the condition.
As regards the difference of Private from NHS. Instead of speaking to the one secreatry/appointment manager for the Consultant, under the NHS I have had dealings with about 6 different booking clerks, secretaries or administrators. Instead of seeing one physio therapist I saw 2 physyio therapists sequentially and then a'Medical Physiotherapist(?)' BEFORE I even got to see the Consultant. The Consultant saw me for about 20 minutes and gave me an injection that I could have had 7 months before.
My GP from knowing my condition is one of two qualified Doctors who are authorised to inject (I didn't know this difference existed but apparently it is so!) BUT under NHS rules he has to refer me to a Consultant.
He knew my problem was identical to 8 years previously but unless I said to him "okay, I'll pay for it" he has to refer me to get an injection under NHS rules. Is this daft or what?
These are two anecdotal but accurately reported instances where I feel the NHS is either mismanaged to the point of dereliction of duty or where the bureaucratic systems and/or processes for managing patient care are stuck in a timewarp where people working within the NHS think that the NHS is designed to employ people rather than treat patients in the most efficient manner.
And finally, the one thing about the NHS in the UK that really gets my goat is how it has been sptlit into 4 Countries/Provinces. It now has 4 Health Ministers + a UK Health Minister. None of the four regions/countries operates with a budget that eqautes to the size of the population so that England's NHS is now the poor relation with Wales, Scotland and NI providing free car parking, Wales providing free prescriptions and NI and Scotland shortly following suit. For England the UK Health Minister has categorically stated that "as only 12% of Prescriptions are paid for by patients there are no plans for prescription charge to be dropped!"
Personally, and again this is anecdotal, the 12% of prescription charges being paid must always be paid by the people in the same queue as me at the Chemists . . . I have to pay and so does everyone else at the Chemists I go to! I have tried changing Chemist to see if I can see people who don't have to pay but the other prescription charge payers must follow me around. It is most strange - unless the Heath Minister was misusing a statistic or being economical with the truth?
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I presume that one of the main purposes of the initiative is to give us all the feeling that the "EU" is doing something useful and to try to change our attitude to the "EU".
BUT
Even if they produce a fantastic pan-"EU" health service which is the best in the world, it will still not mean that we need the "EU".
We could co-operate with other countries in Europe and elsewhere on health without the "EU". We could co-operate with another group of countries on some other issue. The second group could include some of the first group or not.
We just don't need the "EU". The "EU" is about the creation of an empire which could easily turn into a fascist monstrosity.
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Menedemus
Number 48
12% of prescriptions might be paid for, but that doesn't mean that 12% of patients pay for prescriptions. I think it is safe to say that the vast majority of prescriptions are written in hospitals for inpatients and thus not subject to a charge. When you take the small number that remains, I think that you will find that the figure is significantly larger.
If you were to subtract the people who don't pay under the exisiting rules then the burden of presciption charge will fall on a small proportion of the population.
Lies, D**n Lies, and Statistics.
Never trust figures quoted by a Politician
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MarcusAureliusII....
I know that the European Union is trying to control everything, but i was trying to be polite in my point of view.
about the coffee remarks, i know i should, but i rather smell the flowers.
[At 04:50am on 04 Jul 2008, MarcusAureliusII wrote]
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Menedemus @ 47
Thanks for your reply and congratulations on the safe birth of your granddaughter earlier this year.
I share your concerns about the problems of the NHS. I feel that money spent on the NHS has not always been spent wisely and efficiently. The number of managers has grown disproportionately to front line staff. That was another reason why I opposed the the proposed EU directive as that will increase bureaucratic expenditure at the expense of providing front line services to patients for whom travelling abroad for treatment is not an option.
I also agree that it is a nonsense to split the NHS into 4 parts covering the constituent parts of the UK. All this does is increase cost and inequality which undermines the NHS. On the current arrangements, it is clear that the majority, those that live in England, lose out.
I have just watched a programme on BBC2 on the foundation of the NHS 60 years ago and the fight Bevan had with the medical profession to sign up to the NHS. There was at first overwhelming opposition from the doctors but this was countered by overwhelming support from the public. Bevan and the public won but the doctors also got a very good deal from Bevan (they were allowed to keep their private patients and work for the NHS) and they have served the NHS well ever since.
The programme pointed out that the foundation of the NHS led to a dramatic improvement in the health of the nation. Childhood mortality rates from infectious diseases fell through the floor and life expectancy increased sharply (marcus please note!). What truly surprised the doctors and the Govt was that the foundation of the NHS revealed just how many people were suffering from completely treatable afflictions, like massive hernias, because they could not afford medical care. Medical help wasn't sought in many cases until it was too late. All this ended with the foundation of the NHS but still continues today in America.
If you missed the programme, I'm sure that it will be available on the BBC iplayer. I hope our American friends watch and learn from it because it seems clear to me that we in Britian have succeeded these last 60 years where America has failed so miserably in looking after and improving the health of the nation, particulalry the poor and middle class.
The poor and middle classes, who are crippled by insurance costs and insurance companies that don't pay up when required, need a Bevan to drive forward an NHS for America. It won't happen because vested and selfish interests in America block every move in that direction. As a consequence the American health care system will become more and more elitist as rising costs put health care beyond the reach of more and more Americans every year.
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It is not nonsense that the NHS is split between England Scotland Wales and Northern Ireland - each country's Healthcare system should be accountable to its own electorate under the various devolved Parliaments and Assemblies.
What is wrong however is the democratic deficit that allows all 4 countries' MPs to vote on English matters. As the system is currently set up,it is bound to be that self-interest of Scottish, NI and Welsh MPs will cream off the best funding for their own people, and it is not surprising that England gets a rotten deal. This will continue until the devolution process started 10 years ago by Tony Blair is completed and England gets its own Parliament, or outright independence (I personally favour the latter) - but that is an entirely separate debate.
According to Busby2's logic (post 42), it would then be a matter for England's parliament (and England's parliament alone) to decide whether the English should get free treatment in Wales Scotland and Northern Ireland, which to my mind just goes to show how perverse the effects of such a narrow and nationalistic view of the world can be.
As for the reocipircal healthcare arrangements are concerned, they have of course been indirectly approved by the UK Parliament and they are probably one of the most universally popular results of EU membership in this country. What is now proposed merely extends this.
My own view is that it could serve to put some badly needed limits on the powers of local NHS Trusts to make life and death decisions on the patients in their care, and drive up standards of "customer service" in a world where customer service is an alien concept, with its "you will have what we decide to give you" mentality.
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''I feel that money spent on the NHS has not always been spent wisely and efficiently.''
True.
The reasons why will only become clear if you examine the agendas of those who draw up the spending plans...
The ones who want to sell bits of it off, on the reasoning of it being inefficient and 'unrealistic' for the modern technology and sensibilities of patients. This is compounded by their bad decisions in recent years on how to spend the increases in budget.
Extra managerial strata, generally regarded as unnecessary and disruptive to the process of actually providing provision to the people to the UK.
Bring an end to the disruption and waste.
We must be realistic in our expectations. New treatments are expensive; and are available on the private practice menu anyway... so the NHS not being able to provide every treatment is not a criticism that can be aimed at the NHS itself... and no advocate for NHS sell-offs would dream of criticising the high prices of new procedures (in some cases for good reason); but it is not a reason to reduce our basic provision provided by the state.
We will see a medical underclass develop as has not been seen since 1950's.
If you haven't noticed education and social skills are going the same way. We are no longer a cosmopolitan nation.
As a society we need to not choose to promote an uninformed, unhealthy, unsustainable, uneducated, unprepared and under valued population.
...and all the while say we are moving towards 'freedom and prosperity'.
Freedom and prosperity for who, exactly?
...I would expect these ideals are for those who can afford all the latest treatments without ever a need for state help. And I would imagine they will receive a tax break and a subsidy for their none trouble.
We have been promised everything and denied it all in the 21st Century.
Where did we go wrong?
Trusting Blairs, Browns, Mandelsons, Camerons, Bushs et al. to deliver on any progressive, fair, free, wanted or required legislation/ provision.
They appear to be Misanthropists.
At least they are starting to admit their real intentions; their supporters outright encouraging the mass depopulation of our planet...
Scary stuff.
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SuperJulianR @ 52
I agree with you that the Two Kingdoms, One Principality and One Province should ideally have control over how NHS Money is spent in their areas.
I also agree that it is astonishing that the Midlothian question has still not been resolved and Scottish MPs are still allowed to vote on issues singularly affecting England only but this is unreciprocated for Scottish Matters - there being no English representation in the Scottish Parliament.
However, I do not see that as the main problem. My issue is that Wales, NI and Scotland are able to determine how a stipend from the Treasury should be spent in their areas through their respective 'parliamentary' Assemblies.
The stipend from the UK Treasury purse is not equitable with the tax revenues from all four regions and so the larger England electorate is not only funding England spending but subsidising what would be overspends in the other less populated regions.
Basically 55 million people are subsidising 10 million people to have free prescriptions and car parking within the regional NHS spends whilst similar benefits cannot be afforded by the NHS in England.
This is neither right nor fair.
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Pedantic point of detail:
There is only one Kingdom. The Kingdoms of Scotland and England ended with the Act of Union in 1707, and were replaced with a freshly minted Kingdom of Great Britain.
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little addendum:
"The EHIC, which replaced the E111 form, entitles you to reduced cost or free healthcare in most European countries if you fall ill or have an accident whilst abroad - but only if it is in date."
In other words, we are all entitled to healthcare, wherever we are (in europe).
Avoid dentists in Bucharest though ;)
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Wopitt @ 55
A nicety easily resolved though. To separate England from Scotland the repeal of Act of Union is the mechanism to achive this. This would re-create the Kingdom of Scotland - if the Scots were to wish this on themselves.
Following the line of thought of SuperJulianR's comments at @ 52, it would seem logical that, if "it is not nonsense that the NHS is split between England Scotland Wales and Northern Ireland - each country's Healthcare system should be accountable to its own electorate under the various devolved Parliaments and Assemblies ...", then each country and NI should be separated entirely from one another - no shared funding, each parliament or assembly responsible for taxation, defence, home affairs, foreign affairs as well as health affairs.
I would actualy like to see this happen as the model for good relations between the Celtic and Anlgo-Saxon countries is Ireland where the creation of a separate state has been good for the Irish and good for the British.
The separationists have often been thought of as disgruntled Welsh and Scots but there is a growing body of English people who would like to see and end to the parasitical nature of the United Kingdom.
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Re 11: Frenchderek "The evidence from many different sectors and from across the world is that competiton leads to greater efficiencies and improved service - the alternative being to go out of business."
Your sentence to be true should start as follows: "There is *some* evidence from *some* sectors in *some* places..." etc. While competition is great in sectors such as telecom and air transport, it is not as efficient as you claim it to be in health care (see USA) and in public transport (see UK).
On the other hand, I don't see the EU proposal as opening for competition the different health systems, but rather giving the right to citizens of the EU to obtain treatment wherever they are in the EU. An estimated 0.5M British pensioners (i.e., people who do need care) live in France, Spain and other countries... their support should be automatic and they may wish to come back to the UK should they want to do it without hassle.
The same applied in the reverse direction. There is about 2M non-UK EU people working in the UK (I'm one of them :-) and, having tried the NHS first hand, for anything serious I would go back to Italy to seek treatment. Italy, by the way, is very similar a system to NHS (as opposed to the mixed systems of France and Germany), but higher quality (believe it or not!) at least in the north-centre of the country.
Granting health treatment rights across the EU is only a natural evolution of the EU as a civilised legal system. Single countries, each with its system, should take notice and improve accordingly.
As for the doom-monger xenophobes on this blog, I say don't get worked up over it too much, the NHS is quite poor compared to other systems (the only thing that is better is the amount the medics bag home!). The UK can only benefit from this opening up...
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Menedemus, I respect your opinion, but where do you stop?
The Republic of Yorkshire?
The Union of Soviet Socialist Repulics of Devon and Cornwall?
The Greater London independent territory?
Or should we go further? The Duty-free Democratic league of filthy rich white men who wear Prada suits and live within half a mile of Kensington Palace Gardens?
There will always be a parasitic element to the population how ever small the area.
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Re #59 G-in-Belgium
You have a point, but it's against the drafters of the UN Charter and I think they've all shuffled off now. Anyone know for sure?
Read the Charter and you'll see how vague the right of self-determination is.
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While on a visit to England I was taken ill. As I had the correct form to claim any payment for treatment I presented it to the hospital administration.
They were not interested, I was treated free of charge!
Maybe someone should look the extra load on the administration of hospitals this new idea will cause before it becomes law.
Jay Tee Belgium
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What this will inevitable lead to, is German, Dutch and British taxpayers paying for the healthcare of Romanians and Bulgarians (and all those other countries they plan to admit).
I'll have none of that, thank you very much, overtaxed as I am now.
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mcdv_1975 @62
I am not sure I understand how this legislation will harm the uK Taxpayer as you think it will?
If I were travelling to the UK as an EU citizen and fall ill, then the experience of jaytee96 @ #61 will likely happen - free treatment anyway!
The NHS is incapable of pursuing fees for treatment for EU travellers to the UK and certainly not for health tourist from outside of the EU! Therefore the drain on the UK NHS cannot be any worse than it is now.
Even if, after this legisaltion were to come inoto force, there was a deluge of people from outside of the UK entering the UK to attend treatment within the NHS the NHS is merely going to cope as it always does. The clerical administartors will continue to be baffled as to how to claim back the costs so the treatment will be provided for free.
My opinion is that with NHS waiting times and the bureaucracy these foreign patients would be mad to come to the UK as this legislation actually makes it easier for them to go to other EU countries to take advantage of other countries' hospitals and medical expertise.
However, as a UK citizen I could take advantage of travelling to lacerniagigante's Italian Hospital (where lacerniagigante's experience suggests the treatment and healthcare is better than the NHS) and take full advantage of the Italian Medical System. The cost of treatment is on a quid pro quo basis so I cannot get any treatment that is not already funded by the NHS.
Thus, I see this legislation being no worse for the UK Tax Payer anymore than the NHS is already but I can see distinct benefits for those patients with wealth and/or private health care insurance from the UK who will be more able to go abroad for treatment - if they want?
A kind of "Lose nothing" and "Win something" situation for the UK citizens.
As before, my only real concern is that this benefit is restricted to the wealth Brits and/or those with private healthcare insurance who have the means to pay up front.
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The following BBC report of the breakup of the Austrian government is amazing:
http://news.bbc.co.uk/2/hi/europe/7493842.stm
It completely ignores the socialist parties change of policy on referenda on "EU"-treaties. If the Lisbon treaty is not ratified by all of the "EU" countries and is followed by another version then the socialists would want a referendum.
I find this omission so amazing that it looks like the work of the Ministry of Propaganda.
Presumably the point of keeping quiet on the referendum issue is to not give hope to "EU"-phobes.
There is hope and we still have the right to a referendum.
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From the Austrian radio website:
The [Austrian] Chancellor: "It is important to recognize that we cannot carry on like this and that more and more people reject Europe. It is necessary to take a step towards them."
(my translation, the BBC will not allow me to include the original)
The "step" towards them is the recognition of a right to a referendum on "EU" issues.
Please can the BBC explain why this aspect of the goings on in Austria appears to be being ignored on the BBC website. Is the BBC website nobbled? Is the BBC nobbled?
The anti-democratic conspiracy against the peoples in the "EU" seems to be cracking up.
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SuffolkBoy, I don't know what that matter has to do with this post, but anyway...
My country (Spain) held a referendum on the EU Constitution (not the Lisbon Treaty, the Constitution). The "yes" won by a landslide (not that that got much coverage in the British press). Now, the Constitution has been dumped and *our* democratic will has been ignored. Are the only referenda you like those that go your way?
I'm somewhat in favour of referenda for EU issues...but then *only* if they are EU-wide.
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RCalvo
Spain has been a major beneficiiary of EU funds since they joined the EU. I expect Spaniards associate membership with increased standards of living.
Spain is also a new democracy and the transition since the death of Franco has not been that easy, has it? I expect many Spaniards may see membership of the EU and support for the EU Constitution as helping to strengthen democracy in Spain and as a "thank you" to the EU.
The countries that have voted No to the Constitution and the Lisbon Treaty, when given the opportunity to vote, have been long established and secure democracies who do not see the EU as being necessary for their democratic freedoms. In fact, the contrary view is taken as they see the EU as removing some of their democratic rights to govern themselves. This view was evident in the Irish referendum.
You also say that your democratic will has been ignored over the Constitution. You should be so lucky as to have been given the democratic right to vote at all. This is something we have been denied here in the UK because our leaders knew they wouldn't get the Yes result they required.
Wherever possible politicians have sought to deny voters the right to vote if they considered there is a chance the voters would vote No in a referendum. They didn't want the Irish to vote as they hoped to get the treaty approved without any of the electorate of the EU having a say on the matter.
So whilst you might wish there to be EU wide referendums on major EU issues like the Constitution/Lisbon Treaty, we both know this won't happen. The EU is only interested in democracy when our leaders can be guaranteed a Yes vote. They are very similar to Mugabe in that regard.
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RCalvo (66): There cannot be an EU-wide referendum on a fundamental constitutional issue such as who decides the supreme law of the land (which the Lisbon treaty does in many policy areas). This is because the 490 million that live in the different EU countries do not regard themselves as a single polity that would agree to be bound by a pan-European majority, that differs from the majority opinion of one's fellow countrymen. Indeed your own post confirms this because you feel that the referendum result in Ireland (and presumably those in France and the Netherlands) should not bind your fellow Spaniards who voted differently.
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Busby
You spend several paragraphs trying to make the "no" votes seem more important than the "yes" votes. Sorry, but I don't see why the vote of an Irishman should have more weight than that of a Spaniard, and several times more Spaniards voted "yes" to the Constitution than Irishmen voted "no" to the Lisbon Treaty.
Fact is, it's those like you who refuse real democracy in the EU by opposing all attempts to remove national veto powers going against the democratic will of the majority of EU citizens.
You also say that "the EU" is only interested in democracy when "our leaders" can be guaranteed a "yes" vote. Sorry, but which EU? And which leaders? You make it sound like an evil single-minded conspiracy, when in fact the EU's decision-makers (who just happen to be our elected politicians) hardly ever manage to agree upon anything, and normally very loudly disagree about everything.
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"Freeborn": Many in Scotland do not see t