BBC NEWS | The Reporters

Sparring over healthcare

Mark Mardell
2 Jul 08, 09:10 AM

Given that pictures are so important for TV it is perhaps funny that I sometimes form such strong mental images of the people I am going to interview. On my way to Ghent, to film ahead of today's European Commission proposals on healthcare, I imagined the Italian gentleman I was going to meet ahead of his hip operation. In my mind's eye he was a rather wizened, bent chap in his 80s, wearing a dark green checked suit and for some reason an alpine hat. Paolo Bolaffio

Paolo Bolaffio turned out to be rather different - a muscled, vigorous man in his 50s in shorts and a sports vest, who tells me he is an international sportsman, a three-time world karate champion, who it turns out has established his own school of the martial arts. But he's done his hips in, and an earlier operation hasn't helped.

So he's come to a clinic along Ghent's leafy millionaire's row to be put right. Now, in Italy, and I presume in most EU countries, you can get hip operations as part of the national health service or its insurance-based equivalent. Ever since 1998 the European Court of Justice has been making rulings, on the grounds of free movement, that patients have the right to get their money back for healthcare received abroad within the EU that they could, in theory, have got at home.

But Paolo tells me the Italian government couldn't tell him if he would get at least some of his money back. "I just went there and asked and they said they would have to think about it. They're still thinking. They say they have the summer time, vacations, and lots of things to do. That's the problem." And they didn't want him to have the op before they had made their decision.

"They said: 'You can't have the operation until we give you permission. If you do it first we don't feel like giving you the money'. So I told them the doctor said I needed it urgently. But they said: 'We don't care. You can only go once you have the permission, because of bureaucracy, and we'll tell you in August or September'." So he probably won't get any money, but he will have the operation.

It's exactly to make the rules clearer after all the court cases that the European Commission has been working on new laws. In fact they have been working on them for five years now. Their plans were meant to be unveiled just before Christmas, when I wrote a couple of articles about the ideas. But the directive was pulled at the last minute, apparently because of objections by the left and some nation states.

We will know the exact details later today, but it will still say that member states have to reimburse the cost of any healthcare that would be provided in their own country, but in the case of hospital care they can insist that the patient gets approval from the relevant authority if "member states can provide evidence that the outflow of patients resulting from the implementation of this directive has such an impact that it serious undermines the planning and rationalisation carried out in the hospital sector".

Whatever this means I am sure many governments will try to prove that their planning would be seriously undermined, so they keep control of the situation.
A lobby group for patients' consumer choice, Health Consumer Powerhouse, very much welcomes the plans. But one of its directors, Kajsa Wilhelmsson, says they have been watered down. For instance, a reference to getting your money back in three weeks has totally disappeared.

"It means that you will potentially have to wait for a very long time before you are reimbursed. Can all patients really afford that? I would doubt it. You might know how much it will cost, but you wouldn't necessarily know when you would get the money back, and you would have to pay upfront in several countries for the care given." Pills

She thinks many governments are just frightened of the plans. "I think they're a bit scared of this, as it will give more powers to the patient and transform healthcare by increasing the transparency in different quality of care in different countries and they will be pointed out that maybe they are not as good as they claim to be."

Bu others think they are right to be scared. The former UK Health Secretary, Frank Dobson, told me: "Matters to do with healthcare systems are supposed to be a responsibility of national governments, but the European Court and the Commission have decided to poke their nose in and they shouldn't be doing it. And if there are benefits from it for people in Britain they'll go to people who are better off, because they will be able to afford to go to get treatment somewhere in Europe, rather than in Britain. And also people will be allowed to top up the cost. If they persist in pushing this I think Gordon Brown should just tell them to stuff it."

Back in Ghent, Paolo is preparing for life after today's operation. An expert not only in unarmed combat but also oriental weapons, I catch him experimentally twirling his crutches. Maybe the Italian government should take note, and pay up.

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1. At 09:54am on 02 Jul 2008, DannyCool170 wrote:
Dear Mr Mardell,

Just a couple of editorial things: when putting links, you could make sure you align them over the words themselves, so as to avoid overspill.

Also - 'serious' should be 'seriously' in the quote.

I also think you aware that the expression is 'martial arts', not 'the martial arts', regardless of what the name is in Flemish / Italian.

Finally - I hardly think the guy is an expert in martial arts given he's done his hips in.

Anyway - other than that, keep up the good work (especially on the Lisbon Treaty).

Regards,

Dan

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2. At 10:20am on 02 Jul 2008, Menedemus wrote:
Mark,

What I like about your blog is it is (a) written without bias and (b) mere mortals "who may speak common!" can understand you without have to refer to dictionaries and thesauri!

I am sure you'll survive supercilious comments about articles written in a Blog (for Heaven's sake!) and continue to 'keep up the good work' whether it is about the Lisbon Treaty or not!

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3. At 10:57am on 02 Jul 2008, Menedemus wrote:
I am just thumbing through the holiday brochures now.

There is a very nice hospital in Paphos, Cyprus where I could receive a new hip. It has a pleasant sea view and the view from the balcony is breathtaking.

The summer sun and the dry warmth could certainly help with recuperation - I think I'll go for 4star hotel . . . no, better make it 5star!

This is so much better than my local hospital in the UK and the good thing is I can afford to pay for it up front.

I can't wait for the UK to give up it's retained sovereign power over Health to the EU! I could have the NHS pay for my holidays every year . . . . a little nose job here, a freckle removed there, a little IVF treatment somewhere else, I have always wanted a breast augmentation in Barcelona.

Ah, but therein lies a problem. Not all countries offer the same levels of healthcare or treatments and so some countries might refuse to pay for treatment obtained elsewhere under the entitlements granted by this Directive! What happens then?

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4. At 11:04am on 02 Jul 2008, Menedemus wrote:
Like all domineering forces, the EU is no exception.

It has received remarkable surrendered sovereign powers from its constituent member states and yet it wants more and more and more power.

Your example Italian Gentleman is fortunate and has sufficient means to travel to Belgium and pay for his treatment. He lives in hope that his Italian Medical Authorities will re-imburse him for the cost of his treatment and given the nature of the treatment he, no doubt, will only be able to convalesce in Belgium.

I can think of more picturesque destinations than Ghent but perhaps I am spoilt by having travelled around Europe!

My concerns are several:

Firstly, that only the rich can afford to travel and convalesce having paid up front and this EU Legislation only demands that the patient's Health Care Authority pays for treatment AFTER the costs have been paid direct.

Secondly, that the effort and bureaucracy required recovering costs if the fees are not paid up front will fall unevenly throughout the EU member states. The UK, with it's free-at-point of service, has a longstanding problem with recovering costs from overseas visitors ("Health Tourists") arriving in the UK, obtaining treatment and then departing without paying upfront.

Very approximately 60% of all NHS Authorities admit that they do not pursue the so-called "Health Tourists" and cannot recover the costs incurred. These costs are, therefore, a drain on UK NHS resource and funded by the UK Taxpayer.

Even if the legislation passes in to European-wide practice I can see inequalities arising. I doubt that anyone will not accept that some countries have better healthcare facilities and staff than other countries. As proud as I am of the NHS, I would be the first to admit that I am glad I have private healthcare insurance as I'm not sure that I may not contract MRHSA or worse if I go into a UK hospital. Is it it fair then that I go abroad and tie up a hospital bed in say Spain to the detriment of a Spanish Patient who has an equally important healthcare need as I but cannot receive it as I am paying for my care upfront and may get given priority.

Finally, Frank Dobson is right. The UK has not surrendered our sovereign parliamentary control over the UK NHS and we should say "No" to obliquely surrendering any such power without the consent of Parliament.

I watch the outcome of this potential Directive with bated breath!

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5. At 11:21am on 02 Jul 2008, andfreedom wrote:
Maybe we should put a giant sign at Dover;

"FOR GERMANY TURN RIGHT - THE HEALTHCARE IS MUCH BETTER"

But on a serious note, has anyone thought of the consequences to the NHS, which cannot charge patients, yet those patients could still claim once home for expenses. Not only will this seriously undermine NHS services and funding, but result in a patient getting free healthcare, and an expenses paid holiday.

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6. At 12:09pm on 02 Jul 2008, MarcusAureliusII wrote:
BBC recently ran a story about health care tourism in Israel. Israel boasts some of the finest medical care in the world at comparatively bargain prices. That's probably because of its close links to the US medical system and medical colleagues there. Europe's socialized medical care system long held up as a model for the US to follow is starting to show its warts as the real stories emerge. Shortages, incompetence, poor service, interminal delays even in life threatening cases, mind boggling bureaucracy, and in Britain...apparantly....pure filth and indifference. Same reason for the BSC mad cow disease outbreak. Is there a cultural problem there? When the truth comes out... it shows one more European failure. Justin Webb said in his blog if he was poor he'd rather be sick in Europe than America. Perhaps he should read more and reconsider.

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7. At 12:24pm on 02 Jul 2008, Freeborn-John wrote:
What people want is local healthcare; local doctors that speak their language who can establish a long-term understanding of their condition; hospitals close enough to home that friends and relatives can visit. This is why people complain about a lack of local NHS dentists or whenever a local hospital or medial facility is threatened with closure. This move by the EU Commission does not therefore address any true problem. Once again we see that real-world problem-solving is a distant secondary concern, even an accidental by-product, for the EU Commission whose primary goal when formulating policy is always the transfer of more powers to itself.

Supra-national organizations should not be able to mandate spending programs onto their member states because this removes a basic decision over how tax revenues are spent from the democratic arena. Without the strong solidarities of an pan-European ?demos? (or people), taxpayers will not stomach the closure of local hospitals while being told that their taxes are required - by a force of supranational law that their votes cannot touch ? to be spent subsidizing the healthcare of peoples in other countries.

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8. At 1:31pm on 02 Jul 2008, need4reality wrote:
MarcusAureliusII wrote: ''Europe's socialized medical care... is starting to show its warts... Shortages, incompetence, poor service, interminal delays... mind boggling bureaucracy, and... pure filth and indifference.''

And it is getting worse (at least in Britain) because we move ever closer to the American system 'long held up as a model' for the UK.

We have tendered out and privatised for short term gains and instated another level of useless management and 'experts' (not medical experts) instead of nurses and doctors and in house cleaners who know what they are doing.

We move towards private health care (who by the way use NHS equipment, facilities and staff) and use the resulting failures to further undermine the NHS.

This is not only hypocritical; but highly inefficient (hailed erroneously as a push towards efficiency).

Unfortunately the NHS is seemingly being purposely run into the ground before the EU directive makes privatisation mandatory.

Check the Lisbon small print, its all there.

The true colours of EU are near at hand.

Lose fear: choose love.

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9. At 1:56pm on 02 Jul 2008, SuperJulianR wrote:
It would make more sense to tell Frank Dobson to "get stuffed". Free movement is fundamental to the EU, and it is appalling that some bureaucrat in an NHS Trust - or any other national healthcare provider - can stop a patient getting treatment elsewhere in the EU and recovering the cost.

Properly implemented, this Directive could drive up healthcare standards in all the countries where provision is currently below average - and so what if some of the beneficiaries are "the better off" benefit?(how very "Old Labour" to talk in terms of the politics of envy in this way).

It may also force through a policy change to end the iniquitous and vindicitive system whereby desperate patients are not only denied the best drugs, but then told that they will be denied NHS treatment altogether if they fund the drugs they need from their own pocket.

It may cost a little more, but then the NHS could part fund the cost by stopping the provision of free non-emergency healthcare to non-EU nationals. It is well known that hospitals are currently providing very expensive treatments to patients from outside the EU, with little or no effective cost control - even though they ARE allowed to charge the patients! The rule should be proof of entitlement (evidence of UK/EU nationality), or insurance policy, or credit card first, treatment afterwards. Any business run in this way would soon go bankrupt.

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10. At 1:57pm on 02 Jul 2008, ScepticMax wrote:
Mark,

I know that you have to right about 'Europe' in the widest sense, but surely the wonderful spat between Sarky and Mandy deserves your attention.

I'd be keen on more in-depth understanding as to the nature of the rift. Is it really all about anglo v. franco socio-economic policies or did Carla steal someone's favourite designer?

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11. At 2:27pm on 02 Jul 2008, tuairimiocht wrote:
"Europe's socialized medical care system long held up as a model for the US to follow is starting to show its warts"

Err, there is no european health-care system. That was the whole point of this article, in case you failed to notice. Many European countries shun the NHS-type model for a state-regulated insurance market. On the other hand, in Ireland there is a curious hybrid of private insurance and an NHS-type system for the less well off (it doesn't work). In any case, many European countries are poles apart in matters of health care, so to talk about "Europe's socialized medicine" is both a error of categories and one of ignorance.

Oh and BSE (not BSC) was caused by feeding dead sheep to cows, not by the management structures of "socialized medicine".

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12. At 2:35pm on 02 Jul 2008, need4reality wrote:
ScepticMax wrote: ''I'd be keen on more in-depth understanding as to the nature of the rift.''

I doubt those in the know actually want us to gain understanding. We might ask for actual progress; and an end to detrimental policies next: and in our system that is not allowed to be encouraged...

SuperJulianR wrote: ''...it is appalling that some bureaucrat in an NHS Trust - or any other national healthcare provider - can stop a patient getting treatment elsewhere in the EU and recovering the cost.''

No it isn't.

If you want private care; go private. If you want more NHS services, stop voting for corrupt politicians, further deregulation and unnecessary management.

The NHS has the principal to treat any patient that needs treatment.

Just because those on the continent will not do so without charging for it, does not make the NHS the bad guy, it makes them the bad guy.

I agree however that patients outside the EU who can afford to pay for treatment should not be given free treatment and locals should be given priority.

Do not let EU kill the NHS.

Do not let New Labour kill it either.

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13. At 2:44pm on 02 Jul 2008, chisnapc wrote:
Frank Dobson said "...And if there are benefits from it for people in Britain they'll go to people who are better off, because they will be able to afford to go to get treatment somewhere in Europe, rather than in Britain..."

People will go to where the best services are. If the Government seriously committed itself to making the NHS the best in Europe, this would not be an issue.

With regards to chasing money - my understanding was that the NHS was free at the point of service for people who had paid for it through their taxes.

I think it perfectly appropriate to charge a non-resident up front for any non-emergency procedure.

#5 has concerns about expenses, presumably after reading #3. The NHS could pay for the cost of the operation and associated recovery in hospital.

I think it appropriate however, that a patient should be made to fork out for the flight and any hotel stays!

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14. At 3:06pm on 02 Jul 2008, Freeborn-John wrote:
JulianR (9): Frank Dobbson?s point is that this EU directive will allow patients who can afford to pay up front, to get access to UK state-subsidised healthcare overseas. The resul twill be the diversion of NHS resources to hospitals and medial facilities in other countries. That shortfall can only be made up by higher taxes in the UK, or by cutting back on NHS facilities in the UK. In addition it will create incentives for citizens of other EU countries, to come to the UK and be treated at a low cost made possible only by the largesse of UK taxpayers.

I would accept such changes if they are put before the British people in a general election, but these changes have been introduced by unelected judges on the ECJ who exploit the ambiguity of EU treaties to rule in favour of any integrationist measure. Unelected judges should not be able to exploit the supremacy of European law (which is only supreme by another of their rulings) to take major issue of public spending out of the hands of voters and their elected representatives. I do not see why Frank Dobson should be told to 'get stuffed' as he and his party can be removed from office at the ballot box, which is not something that can be said of the politicians in black robes who sit on the ECJ.

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15. At 3:17pm on 02 Jul 2008, G-in-Belgium wrote:
Don't let the EU kill the NHS???

The NHS died in 1949. Is the most useless system ever conceived.

I'm still waiting for an appointment I asked for in 2001.

If ever I fall ill on a visit home, I'll just ask them to ship me out of the country. I'd rather not die of some myserious disease in a shoddy ward at Jimmy's or pay 4500 pounds to hear "well, we can't do much about it".

At least the xenophobes on here can rest easy knowing nobody in their right mind would travel across the channel for healthcare...

Ps. my dear sister-in-law is being laid off as the NHS are "downsizing" their bloodbanks. Allegedly there'll be only three left across the british isles. Don't cut yourselves boys and girls...

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16. At 3:37pm on 02 Jul 2008, ScepticMax wrote:
Mark (and everyone), apologies for writing right instead of write. :(

As for our lauded 'envy of the world' NHS, surely it's time this holy cow was slaughtered. Good healthcare provision is surely one thing we can learn from some of our European neighbours.

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17. At 4:18pm on 02 Jul 2008, Menedemus wrote:
chisnapc @ #13

Regarding your comment, "...I think it appropriate however, that a patient should be made to fork out for the flight and any hotel stays!"

I was being light-hearted and suggesting tongue-in-cheek at #3 that I would like to go to a holiday destination for any medical treatment but I actually think that your comment highlights a fundamental flaw in the EU desire to enforce cross-border medical services.

If I go into an NHS hospital for an operation I presume I do so because it is a medical need.

I then presume that I may need to recuperate and this will be in the form of bed rest and to take it easy for a few days. All part of the medical need and recovery process. Typically the rest will be a short period in a medical ward and then bed rest at home. If I am in work I can get a medical certificate that guarantees me paid leave of absence through Statutory Sick Pay as a minimum recompense for time off work.

If I am able to choose my hospital abroad to have the operation then it would seem sensible to recover and recuperate close to where the delivered operation occurred. Anything else - such as having to fly home - might be detrimental to my recovery.

Thus, I would suggest that reasonable board and lodging would be a necessity to support the EU proposals in addition to any medical expenses incurred. I would also need the minimum Statutory Sick Pay to really enjoy my rest!

Otherwise, it reinforces my belief that the benefits of this legislation will merely accrue to those able to afford to travel and enjoy medical care across borders.

For the British, this could mean a three-tier NHS - the poor without medical cover other than their National Insurance only getting NHS treatment, those with private healthcare insurance that only allows for medical care in the UK using paid-for NHS services or private facilities in the UK and those with wealth or private healthcare insurance that allows for medical care services anywhere in the EU.

I truly believe that this legislation will only truly be a benefit enjoyed by the wealthy and be a boon for the private healthcare insurance companies.

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18. At 4:18pm on 02 Jul 2008, need4reality wrote:
@G-in-Belgium no.15

I think the NHS as been stifled since 1949; not killed in 1949...

The promotion of bad practices and the strangle hold of the pharmaceutical industry; the focus on curative rather than preventative medicine: generally a disdain for public safety compounded by taking what provision we have for granted.

Our demands have grown; while real innovation (by that I do not mean aggressive private finance) has been limited.

So called 'failure' of the medical system has consistently been blamed on the NHS, not on those making stupid decisions; and those that profiteer in the publicly funded system.

NHS staff are given cruel hours and paid miserably. Tired under appreciated staff are not the answer to the problems.

The aspirations of the few are triumphing once again over the needs of the many.

If you want private: go private.

Stop allowing private practice to co-opt NHS facilities to jump waiting lists for the rich. The NHS isn't dead yet; but they are strangling it as we speak.

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19. At 4:51pm on 02 Jul 2008, frenchderek wrote:
I'm surprised to read of countries who had previously shown themselves to be so enthusiastic for a "free-trade" EU. This is one "free-trade" proposal that is being watered down (having failed to shoot it down) by the UK gov't amongst other pro-free-traders.

If exercising one's profession wherever one chooses in the EU is allowable, why should it not be allowable for customers/clients to seek out the best deals wherever they can in the EU? That's free trade (aka market forces) isn't it? The customer/client/patient pays.

If the health care services are provided by a nationalised service at the tax-payers' cost (ie professional and other staff, plus buildings and equipment, etc, paid for by taxation) then that country would expect to recoup the costs from users.

If those users were "insured" by the state itself against the costs of such use. ie if a country chooses to pay for the health care of its own citizens via their taxation system, then that is the "purse" which should provide the funds for the care. Other users eg non-residents would be expected to pay for care - either from their own funds or from their own "insurers" (whether private or state).

Clearly most insurers have rules on what can be claimed and how eg I need an Assessor's report before I can have major repairs to my car after an accident. But that's a normal aspect of market operation. So, it's quite reasonable for states to have rules about "free choice" in health care provision if the market requires.

So, that's what this proposal was/is about, I thought? A straightforward set of free trade market activities?

BTW, Mark, we're not talking solely of hospital treatment in this Draft Regulation are we?.

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20. At 4:53pm on 02 Jul 2008, frenchderek wrote:
Mark

I forgot to add - whilst this "Sparring" about health care is important, much more interesting to have a blog on the "fist-fight" (literal, we hope) between Sarko and Mandelo.

Cheers

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21. At 5:28pm on 02 Jul 2008, chisnapc wrote:
to #17 Menedemus,

Many thanks.

I understand that bed rest may be a necessity after an operation, however if the NHS is to foot the recuperation bills while in a hotel that may cause a lot of cash to leave the NHS at a time when it needs it the most.

Unfortunately the system you advocate does not help the poor, merely penalises the rich. If a person is incredibly wealthy, why should they not seek out the best they can afford?

Instead they are required to leave their bank accounts on hold or face their right to free access of the health system removed. They paid for it with their taxes (presumably if they are rich they have contributed a larger amount of money) but would be asked to pay again.

I doubt anyone would willingly take the 2nd or 3rd best option with regards to their own health just so the poor don't feel envious of them.

Indeed if all of the rich people go abroad, 'removing' themselves from the waiting lists, I contest that not only have they helped pay for the system, they are also reducing waiting times for those who stay.

Again, I stand by my original comment that non-emergency health care to non-residents should be paid for upfront.

The rich leave, the poor have less people in the queue and 'Johnny Health Tourist' has paid his dues too!

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22. At 5:28pm on 02 Jul 2008, Menedemus wrote:
frenchderek @19

Actually, there I was defending the right of the UK govermment to ensure that the NHS was not two-tier and prevent it form possibly becoming three-teir with free access to medical care abroad.

But, I think I now agree with you that the NHS is indefensible as it does recieve income from private healthcare insurance and I believe you are right to say that the UK should be supporting free market forces whether it be supplier or customer driven.

If the other nation states health care is better there is no reason why the UK should not send our elderly, sick and needy to these other countries for treament.

Alternatively, the UK government could improves the NHS services/faciltities and makes it fee-paying service to cash in on the new demand from the rest of Europe.

British Citizens could be exempted from the current burden of National Insurance as all patients are equally able to access private healthcare insurance (whether they can afford it is another matter) and let free market force either kill the NHS or improve it!

You've convinced me. When is this likely to happen do you think?

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23. At 6:21pm on 02 Jul 2008, need4reality wrote:
Menedemus wrote: ''British Citizens could be exempted from the current burden of National Insurance as all patients are equally able to access private healthcare insurance (whether they can afford it is another matter) and let free market force either kill the NHS or improve it!''

So it is acceptable in your view to have an American style system that leaves large sections of the community behind; and defrauds the middle classes of their cover wherever possible.

A Rich man's utopia indeed.

Heres to War, Pestilence, Famine and Death for the 21st century.

chisnapc wrote: ''...just so the poor don't feel envious of them.''

The very existence of the 'poor' in this day and age is an absolute disgrace; and remember all you rapture right wing hawks, when the 'legion of angels' comes down and God passes judgement:

The rich ain't going nowhere near the pearly gates...

See you in hell fascistos!

For all the human beings (you know where we get the word humane, right?):

Lose fear: choose love.

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24. At 6:52pm on 02 Jul 2008, Menedemus wrote:
need4reality @ 23

I have been trying to be light-hearted with all my comments and replies in this thread!

The chances of the EU Commission getting national government to surrender more sovereignty over Health to the EU - as this legislation would do - is zero rather than simply to bend any more than they have after the 1998 European Court of Justice ruling, on the grounds of free movement, that patients have the right to get their money back for healthcare received abroad within the EU that they could, in theory, have got at home.

I may be proved wrong but I just cannot see a socialist UK government ceding more patient-power - given the sanctity of the NHS to the Labour Party in the UK. If the Labour Party were to do anything it is likely to be adding a tax on top of the insurance tax on private healthcare insurance.

On the other hand, if we could discuss President Sarkozy and Peter Mandelson, and their public spat, the CAP in the 21st Century and whether we should have free market european integration or having the social political leanings of the EU curtailed then we could be discussing something that might just happen - and I would hang up my light-heartedness and be more serious.

Oh, and by-the-by, I am not a right wing hawk. I am far from that as it happens.

Dash it! I've gone all serious now.

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25. At 7:10pm on 02 Jul 2008, NikolayTzvetkov wrote:
I think this sound like a really good idea. It will bring competition between the healthcare systems will improve the choice available for the patients. I guess it will also help some of overstretch countries as well.
Take UK, NHS is based on Darwinist principles. You are sick, well come in 2 months (I should admit that New Labour brought some progress, it used to be come in 6 months or an year). By then you are either cured or dead. My ex was English and she needed minor surgery and we were lucky that were living in Germany. She got the documents sorted out by the GP in a couple of days. She could choose between a big university hospital with a longer waiting time (two weeks) or a private clinic that was available in week. She chose the second got a really great treatment. The public health insurance covered it completely so no extra payment was needed. Here you pay extra only if you want special treatment like private room, to be taken care by the head of the department and so on. But overall quality and speed are really good and that?s what matters most. I guess many British people will benefit from the new rules and so will NHS as they will get more doctors on call so to say and often cheaper. I guess the losers will be UK medical professionals.

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26. At 8:25pm on 02 Jul 2008, Brownedov wrote:
Re #24 from Menedemus: I have been trying to be light-hearted with all my comments and replies in this thread!
.....
I may be proved wrong but I just cannot see a socialist UK government ceding more patient-power - given the sanctity of the NHS to the Labour Party in the UK.

Good try, but I'm afraid there's nothing socialist about NuLabour. As the Supreme Leader so ably demonstrated over the 10% tax band, NuLabour have about as much socialism left as did the National Socialist Workers' Party in Germany by the time Adolf Hitler came to power.

Given NuLabour's love affair with the EU - perhaps to provide a bolt-hole a la Mandelson, Kinnock et al when they are thrown out of UK politics? - I cannot see anything persuading The Supreme Leader to rock the boat with his new EU chums.

It is clear that Brown could win back some popularity simply by rolling back a few of NuLabour's more extreme policies, but his unwillingness to do this can only be to "salt the well" for the next lot in power.

Personally, I never want to see a Tory government in power again, but given the folly of the LibDems in choosing the EU over democracy it's hard to see who else to vote for next time, at any rate in England. In Scotland and Wales the shift will almost certainly be to the nationalists and it will be fascinating to see the outcome of the Glasgow East by-election later this month where an SNP win might just unite the rump of "old" Labour enough to topple the current NuLabour Politburo sooner rather than later.

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27. At 9:12pm on 02 Jul 2008, need4reality wrote:
Sorry, Menedemus, wasn't labelling you... that was directed at the actual rapturist right wing hawks; and please don't be serious. My
comments arenot to be taken too seriously :)

Menedemus wrote: ''...socialist UK government''

Where? I see New Labour, right-centre-right... and corrupt to boot. They're having a ball in Westminster though, if anybodys been invited...

No, me neither: only arms salesmen and corporate finance are on the list; and if you aint on the list, you aint coming in.

@Brownedov

We are indeed, now riding the sewer without a paddle.

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28. At 9:52pm on 02 Jul 2008, busby2 wrote:
MarcusAureliusII in reply to Post 6

I would be prepared to take your comments on the NHS more seriously if you saw the problems in your own American health care system which:

(a) costs far more than any other country in the world (you are being ripped off big time)

(b) Leaves you 41st in the world in terms of life expectancy behind all of western Europe, including of course Great Britain and Canada

(c) fails to provide anything except the very basic emergency treatment for the 45 million plus Americans with no health insurance cover

(d) leaves poor Americans with chronic medical but non life threatening conditions with no medical help

(e) bankrupts 2 million Americans every year. Medical insurance is now so expensive that many more cannot afford adequate medical cover. This drives around 2 million Americans to bankruptcy every year as they cannot meet their medical bills.

On top of all this, medical insurance costs are rising at a far higher rate than inflation so all these problems outlined above are getting worse with every passing year.

In short, Marcus, your health care system falls way short of that required in a civilised and supposedly Christian country.

One thing you don't seem to grasp about the medical system in the UK is that you can also choose to take out private medical cover if you wish. You can therefore go private. So you should now be able to see that we have a private system to suit the likes of you and an NHS that covers everybody which your system clearly does not. This is far, far superior to anything in the USA.

No wonder that Justin Webb said in his blog if he was poor he'd rather be sick in Europe than America.

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29. At 11:54pm on 02 Jul 2008, jon_toronto wrote:
It is odd indeed that the people who denounce the EU as an evil "socialist" organisation are the same people who accuse the EU of trying to destroy the UK's very socialist healthcare system in favour of a "European style" privately-run provit-driven system.

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30. At 00:42am on 03 Jul 2008, Brownedov wrote:
Re #29 from jon_toronto: It is odd indeed that the people who denounce the EU as an evil "socialist" organisation are the same people who accuse the EU of trying to destroy the UK's very socialist healthcare system in favour of a "European style" privately-run provit-driven system.

True, but a big part of the problem is that the word "socialist" has taken on two meanings, just as the word "liberation" took on a strange new meaning during and after WW2. There are certainly plenty in the UK who talk of NuLabour and the EU as socialist, but this is in the "liberated" sense of the word in honour of the centralised corruption that, in Lenin's words, regarded real socialists as "useful idiots" while calling itself the Union of Soviet Socialist Republics.

The UK Labour Party, at least from about 1950 to the coronation of Bliar, wasn't a truly socialist party, but it did have more or less socialist ideals, sold down the river by NuLabour in the pursuit of political power and now barely a memory of a handful of older MPs.

And if that's not confusing enough, the "very socialist healthcare system" you refer to was devised by Beveridge (a lifelong Liberal) at the instructions of Churchill (a Liberal who became a Tory) and only delayed in implementation by the small matter of a war for national survival being fought at the time.

Even in Europe, not even a majority of healthcare systems are privately-run and profit-driven, and all EU & EEA countries have a basic state provision far superior to the USA.

True socialists are now a tiny minority in the UK and the LibDems are the most "left wing" political party near the mainstream while many of our Tories would be decried as radical liberals in the USA.

Hope that makes it clear. What was the problem, again?

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31. At 01:01am on 03 Jul 2008, need4reality wrote:
jon_toronto,

I think the danger is a Ultra Right Wing hawkish authoritarian superstate that wants to destroy the NHS.

Communism is dead.

Beware the fascists.

Softly they approach...

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32. At 01:11am on 03 Jul 2008, BradZimmerman wrote:
To tuairimiocht:

It isn't only Ireland that has two health care systems. Poland, too.

My employer pays for private health care in addition extracting the necessary taxes from my paycheck for the public health care system. I have never used a public hospital here and, God willing, I won't for a very, very long time.

The Polish NHS isn't just slow and horribly, horribly callous but is frankly inept in addition to being inefficient. Whereas I've never had a bad experience at our private health care facilities. It was a huge bonus when I joined the company but seems to be a perk that more and more people are getting when they join a large company.

I can only hope that private health care facilities - which typically handle basic or not life-threatening cases - take the burden off the public facilities and allow them to pay public doctors a real, living wage. Maybe even turn on some lights in the hospital hallways so it doesn't look like some WWII-era place-to-die but rather a place of healing and recovery.

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33. At 02:47am on 03 Jul 2008, kcwhattrick wrote:
To busby2 and Brownedov (and all the other Euros on this blog) let me just apologize for the critical comments from my countryman MarcAurelius.

You see we Americans are constantly having it pounded into our heads that you Euros are far, far superior to us. We are constantly being told that you are smarter, more cultured, more sophisticated, better people than we are. Hell, according to you all, we Yanks don't even have culture (although I don't understand how American culture is taking over Europe if that last statement is true). Oh well.

We are constantly being told that we Yanks are horrific, violent, gun loving hicks who like to start wars and bully weaker nations. Thank God you Euros can never be accused of that!

So you see, we tend to get a little upset when we hear that not everything is perfectly rosy with European life. We get a little anxious when we hear that European healthcare systems AREN'T perfect and have (gasp!) problems. It spoils our view of your continent as utopia.

We like to hang on to that fantasy, er, um I mean belief that Europeans are the epitome of civilization. We like to believe that you Euros really are the most advanced societies on this planet (even if you did start two world wars and spent centuries stealing what didn't belong to you).

I'm sure that given enough time Marcus will see the error of his ways and realize once again that Europeans are first in everything and can teach this planet much.

I often wonder how you Euros can stand to share your planet with the rest of us.

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34. At 08:15am on 03 Jul 2008, cat_m_p wrote:
What people should know is that this law has come out of numerous cases where people have to go from one neighbouring country to another. For example people in Luxembourg who need dentists in Germany, Northern Irish who go to a hospital in the Republic etc.
Having studied European Health Law, this idea is more of a safety net to stop people being put totally out of pocket for crossing over their border, rather than encouraging large amounts of health tourism. I doubt this will be such an issue in another six months time.

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35. At 09:19am on 03 Jul 2008, ScepticMax wrote:
jon_toronto @29 wrote:
"It is odd indeed that the people who denounce the EU as an evil "socialist" organisation are the same people who accuse the EU of trying to destroy the UK's very socialist healthcare system in favour of a "European style" privately-run provit-driven system."

Not true. It's possible to dislike both: see my comment @16.

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36. At 10:11am on 03 Jul 2008, Menedemus wrote:
kcwhattrick @ #33

I hear what you say and read your exasperation with us Europeans but I actually enjoy MarcusAureliusII's contributions to the blog and I happen to agree with much of what he has to contribute.

Some Europeans actually like Americans despite the shrill loudness of the anti-American crowd.

I happen to believe that Europe has a lot to learn from the US ("no taxation without representation" was as true in George Washington's day as it is now in Europe!).

And, despite so many people contributing comments suggesting that their beloved EU has been the saviour of peace in our time in Europe, I do recognise the massive commitment that America has made to NATO since 1945 and it is NATO that has actually been the organisation that has maintained the peace of Europe since then.

Sometimes, it's a little hard to say thank you.

I personally have no qualms in that regard and very much appreciate the support of the US for Europe!

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37. At 3:02pm on 03 Jul 2008, need4reality
This comment was removed because the moderators found it broke the House Rules.
38. At 6:31pm on 03 Jul 2008, kcwhattrick wrote:
To Menedemus:

Thank you for your post.

It never ceases to amaze me how many non-Americans (and believe me it's not just you Euros, the Canadians are just as bad) feel they have a right to criticize America, but are none to willing to have their precious countries criticized by Americans.

Right now Americans are being put through the ringer because of our Presidential elections.

I can't tell you the number of times I've been preached to about racism in the US and America having a black President by people whose countries have never even come close to considering a black person for Prime Minister/President.

It does get a wee bit tiresome.

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39. At 9:41pm on 03 Jul 2008, need4reality wrote:
38. At 6:31pm on 03 Jul 2008, kcwhattrick

It is indeed hypocritical. Unfortunately it happens both ways.

It tends to start with someone ho advocates it in their home nation criticising other nations, which then gets the tit for tat 'Euro' v 'Yank' battle of who is the worst. Unfortunately it alienates the good people of both continents who start bickering between themselves...

And if you listen hard enough there is the murmur of evil laughter from the oppressors both sides of the Atlantic...

Sad really, when both sides actually condemn the acts of both.

Ce la vi.

Forget fear: choose love.

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40. At 3:02pm on 05 Jul 2008, Iza_Poland wrote:
I am also a hip-replacement patient who had fought against my national (Polish - "new EU") healthcare system to get operated on abroad. While I agree every - medical or not - service must be duly paid for, I can tell you this provision of "financing what would be financed at home" is a scrap, guaranteeing nothing at all with the current level of avoidance skills of the national systems.
To cut a long story short - in the course of my two-year-long fight I learned that our dear state-run medical insurance system does not finance "hip replacement" as such. They finance "hip replacement, X method". If you don't want to stay on a waiting list for years and choose to seek medical treatment abroad, where on top of it all they offer you a less invasive method, the national insurer says: "Sorry, we do NOT finance 'hip replacement, Y method' at all. You'll have to pay for it yourself or sign up for a waiting list at any domestic hospital."
My response - quite logical to me - was "OK, please pay the part of the bill equivalent to the standard expenditure related to X method and I'll pay the rest." "Impossible, we do NOT finance 'hip replacement, Y method' at all."
Needless to say, I couldn't afford it. :( So much for the seemingly non-discriminating principle of financing "what would get financed at home".

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41. At 08:52am on 07 Jul 2008, rmthomson wrote:
It seems nobody covers my situation. I am an Australian, and a European. Despite my UK passport, I consider Germany my European home, but I currently work in Holland. I regularly take months off to travel and experience other lands and cultures. This time, I will leave Holland (and my contract and apartment) to live in Italy for a few months, learn the language, and spend the time with my girlfriend, and on my hobbies.

As soon as I de-register myself in Holland, I am no longer eligible for dutch health insurance. Not working in Italy, I am not (as far as I know) eligible for Italian health insurance. And of course, private insurance is insanely expensive, and as I've already paid significant contributions to health-care through pre-tax salary deductions (in addition to monthly private contributions), seems rather unfair.

For me, closing these insurance gaps is vitally important, and even if closed, the idea of me having to travel just to get a non-emergency operation in Holland, if I'm effectively living in Italy with excellent comparably priced health-care seems rather ridiculous!

I think it should be quite simple - the last country in which you've worked and paid insurance contributions should be responsible for your health-care in the EU, and to a limited extent outside. Naturally, it's no substitute for travel insurance, but likewise, travel insurance is no substitute for proper health-care insurance.

Similarly, when I first arrived in Holland with my suitcase and a hotel booking, I could not get insurance immediately, because I couldn't register any address. And a German friend returning from Holland will be uninsured for about a month due to a gap between his departing Holland and the start of his new job in Munich. In this respect, I appreciate the NHS's policy of automatic insurance for residents. The rest just seems a little crazy, no?

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42. At 6:40pm on 07 Jul 2008, Buzet23 wrote:
To #41 rmthomson,

I symphasise as you have fallen into one of the many traps that are present within the EU rules, and these traps are on the increase and cover health, social security, residence, pensions etc.
Just a thought, if you keep your Dutch registration and can qualify for unemployment pay, you are entitled by EU law to go elsewhere in the EU to seek work. The maximum time for this is three months and before that has expired you must return to Holland, but during that time you are covered for both dole and health. Whatever you do though you must read all the fine print, good luck.

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Welcome to my blog - I'm Mark Mardell, the BBC's Europe editor. This is where I share my thoughts on the main stories in Europe, European politics and the EU.