The NHS at 60

[belfastuniguy 18]

Viewpoints: Darzi review of NHS

Health minister Lord Darzi has announced plans for significant changes to the way the NHS in England will work in the future.

They include moves to focus on the quality - rather than quantity - of clinical care, and to set up new GP super-surgeries.

Leading figures in the health world give their reaction. Click on the links below to read what they have to say.

"There is much here that could bring about improvement - if it can be delivered." Dr Hamish Meldrum, British Medical Association "He has managed to engineer a major shift in government policy, language, and tone." Dr Richard Horton, The Lancet "This has a real chance of helping to improve the quality of care that patients receive." Sir Ian Kennedy, Healthcare Commission "The ambition now must be to drive up patients' experience from a 'safe' to a 'high quality' service." Dr Peter Carter, Royal College of Nursing

"This will be a new era in which patients will be able to check on the quality of the services they are being offered." Niall Dickson, King's Fund "Lord Darzi's ambitious vision could have enormous benefits for people with dementia." Neil Hunt, Alzheimer's Society "We remain concerned that NICE appraising new treatments earlier will not result in more new drugs being made available to patients." Ian Beaumont, Bowel Cancer UK "Investment needs to follow the grand strategy outlined today." Jon Skewes, Royal College of Midwives

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Dr Hamish Meldrum, Chairman, British Medical Association

"There is much here that could bring about improvement - if it can be delivered.

That will depend on the details, and on the true engagement of NHS staff in implementing change.

We are pleased the government has stated its intention to move away from target-driven health policies and to focus instead on the quality of patient care. Dr Hamish Meldrum British Medical Association

"If they are sidelined, these are little more than fine words and we won¿t see the improvements the NHS desperately needs.

"In some areas there was insufficient consultation with the public or staff on changes to local NHS services during the review process and we don't want to see that repeated in the future.

"An NHS constitution is something that the BMA has called for and the public deserves a clearer idea of what it can expect from the health service it funds.

"The constitution should also empower staff, working with patients, to run the health service locally without the day to day interference of politicians.

"We are pleased the government has stated its intention to move away from target-driven health policies and to focus instead on the quality of patient care."

Click here to return

Dr Richard Horton, Editor, The Lancet

"Darzi has wisely thrown out regulation as the organising principle of the NHS.

"He has replaced it with quality, by which he means clinical effectiveness, patient safety, and the patient experience.

His achievement should not be underestimated Dr Richard Horton The Lancet

"This cultural shift is a radical re-visioning of purpose for the NHS - away from the political command and control of processes and towards professional responsibility for clinical outcomes.

"His achievement should not be underestimated.

"He has managed to engineer a major shift in government policy, language, and tone.

"He has revised the role of the Department of Health to one of setting values, principals, standards, and rights.

"He has also revived the part professionals can play in leading NHS quality improvements."

"Proper attention will be paid to the people who make the NHS what it is -its staff.

"Instead of being criticised, blamed, and threatened, NHS professionals will be consulted more, receive better training (with funding following the trainee), undergo leadership development in the undergraduate and postgraduate years, and have more attention given to their health and wellbeing."

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Sir Ian Kennedy, Chair, Healthcare Commission

"This has a real chance of helping to improve the quality of care that patients receive.

"The proposals should be given a fair wind - they deserve one.

"While we welcome the objectives of this review, it is essential to have an independent assessment of progress.

"The document is somewhat short on how this will come about and the role of regulation. We will be raising this with the government.

"We have been working for the past three years to embed, for the first time, core standards on the care of patients right across the NHS.

"We therefore welcome a Constitution that will help keep the spotlight firmly on standards and the quality of care."

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Dr Peter Carter, General Secretary, Royal College of Nursing

"The RCN welcomes the recognition by Lord Darzi's Review that future healthcare provision should aim for a more quality based approach, and that nurses can play a lead role in its shaping and delivery.

"The overwhelming majority of care provided by the NHS is safe, but the RCN believes the ambition now must be to drive up patients' experience from a 'safe' to a 'high quality' service.

"If fully implemented, these recommendations have the potential to achieve this ambition.

"We also welcome the Review's recommendation to increase investment in nurse education and training.

"And, that in the future the NHS will have a culture where nurse leaders are supported and empowered to effect meaningful change."

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Niall Dickson, Chief Executive, King's Fund

"The good news is that there is no top-down re-organisation or any dramatic changes in direction.

"Instead the report is a sensible set of measures to improve quality and equity, and a clear signal that responsibility for shaping and leading health services lies with staff at local level.

"This will be a new era in which patients will be able to check on the quality of the services they are being offered from infection levels to success rates following operations.

"All this should help us all make more informed choices and put pressure on those providing the care to do better.

"To make this happen we need a decentralised health service, with less central control, leaving local organisations responsible for how they deliver care but accountable for its quality.

"While services provided by the NHS are far from uniform, increasingly devolved decision-making could result in significant regional variations in the care provided to patients.

"So far there are two significant omissions - there are no estimates of how much all this will cost and no indication of just how different the government expects the quality of health services to be in five or ten years time."

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Neil Hunt, Chief Executive, Alzheimer's Society

Lord Darzi's ambitious vision could have enormous benefits for people with dementia.

"Creating 'polyclinics' could potentially give people greater access to memory services and the specialist support they require, perhaps removing the need for hospital visits and ensuring that people get access to an earlier and accurate diagnosis.

"Speeding up evaluations of NHS treatments and giving people the universal right to approved treatments can only be positive.

"Changes must also ensure that that the wider benefits of treatments to society, particularly carers, are considered.

"England's record on dementia care is damningly poor. Currently only a third of people ever receive a formal diagnosis and if they do they are then shunted between a health and social care system that fails to meet their needs.

"The NHS must wake up to its responsibility to care for this incredibly vulnerable group of our society."

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Ian Beaumont, Bowel Cancer UK

"While we welcome the fact that more patients will be able to access NICE approved drugs, we remain concerned that NICE appraising new treatments earlier will not result in more new drugs being made available to patients.

"NICE will still be judging treatments on grounds of cost not efficacy; by appraising treatments earlier, NICE is likely to claim that the evidence for them isn't robust enough; and if the proposed co-payments system is introduced, there will be no incentive for NICE to approve new treatments anyway.

"If the government is genuinely committed to increasing access to new treatments, then NICE needs to move away from its outdated and simplistic QALY (Quality adjusted life years) system and tailor its appraisal process to match the criteria used in drug trials."

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Jon Skewes, Royal College of Midwives

"For too long the NHS has been about throughput and quantity and not about the level of care that people actually get.

"There is no doubt that this document sets out to redress that balance, and the focus on quality of care and outcomes is welcome.

"However, the review is quality and choice-heavy, but the reality in maternity services is too often choice-light, with quality at the mercy of midwife shortages and under-funding.

"If we want to see real quality and choice in maternity services, then we need to see real action. Investment needs to follow the grand strategy outlined today, and the government need to come good on their promise of more midwives."quote>

 

A 60-year revolution in surgery

By Jane Elliott Health reporter, BBC News

Sir John Charnley created the hip replacement

In the six decades since the birth of the NHS, treatment has changed almost beyond recognition.

What was the stuff of fantasy in 1948, such as organ transplants, is now routine.

In 1948, a cataract operation meant a week without moving with the head which was supported by sandbags - now it is over within 20 minutes, and most patients have day surgery.

The first UK heart transplant patient in 1968 only survived 46 days - now 24 are carried out in the same period.

In 1958, hip replacements were so unusual that the surgeon who invented them, Sir John Charnley, asked patients to return them after death - now there are 1,000 every week.

From being an area where nothing was possible it has now become a discipline where nearly everything can be repaired and where the whole organ can be transplanted Tom Treasure, former heart surgeon

To mark the 60th anniversary of the NHS, the Royal College of Surgeons asked members about which developments have made the biggest impact.

Heart surgery

In 1948 any sort of heart surgery was almost unheard of and surgeons could not work a stopped heart as there was no way to keep a patient alive for any length of time.

Former heart surgeon Tom Treasure said two developments in the 1940s and 50s made all this possible.

"From being an area where nothing was possible it has now become a discipline where nearly everything can be repaired and where the whole organ can be transplanted," he said.

"In 1948 around the birthday of the NHS three surgeons working independently operated successfully inside the beating heart to open up the narrowed heart valve and restore normal flow of blood.

Heart surgery was almost unheard of in 1948

"The second enabling step was the machinery to fully replace the function of the heart and lungs so that surgeons could repair the heart and then restore it to action.

"Ever more ingenious means were being devised to operate on the still beating and functioning heart.

"Total body cooling was used to allow the action of the heart to be paused so that the surgeon could hastily work inside it, and children were supported by blood flow from parents for long enough to allow a repair operation.

"And lastly - viewed perhaps by some as the least likely to succeed - was a contrivance of pumps and tubes to do the work of the heart and lungs.

"In 1953 this was achieved and in due course was refined to become usable as a routine."

Day surgery

As treatments developed patients needed to spend less time in hospital. Surgeons say this has not only benefited the patients but the NHS, enabling more operations and cutting hospital stay costs.

FIND OUT MORE As the NHS turns 60, BBC News is giving it a health check. Watch out for reports, features and analysis on TV, radio and the web.

In the 1980s only a few operations were done by day surgery - now 170 different procedures can be done this way.

Douglas McWhinnie, of the British Association of Day Surgery (BADS), said: "In 1948 a relatively simple operation like hernia repair would have meant an average hospital stay of two weeks."

Laparoscopic or keyhole surgery has had a similar effect, according to Professor Robin Kennedy, of the Association of Coloproctologists (colon and rectal specialists).

"With laparoscopic surgery you can recover better and faster, you shorten the stay and lessen the risk of a hospital acquired infection," he said.

Reconstructive surgery

Reconstructive surgery has also seen a number of big steps forward: from the first toe-to-thumb transplant at East Grinstead to whole sections of the body now.

Professor Simon Kay, vice-president of the British Association of Plastic and Reconstructive Surgeons, said microsurgery - the joining together very small arteries and veins to restore the vital blood supply to a piece of living tissue - helped to transform patients' lives.

"This technique has been the single biggest advance in plastic surgery in the last 60 years," he said, "because it allows a surgeon faced with a defect in the body to move tissue from another part of the same body and restore life to the transplanted tissue, so that healing begins immediately.

"An example might be seen after removal of a large cancer from the face, leaving a deep hole that a simple skin graft cannot fill, but which can be repaired by transplanting muscle and skin from the back.

"Microsurgery has moved on to apply this concept widely, so that whole bones may be transplanted to replace diseased structures such as the jaw bone."

Vascular surgery

Peter Taylor, a vascular surgeon at London Bridge Hospital, praised the development of keyhole surgery to treat some aortic aneurysms - a swollen blood vessel below the heart.

"They make it much safer for the patient and the mortality across the board has fallen by at least three percentage points," he said.

"It reduces the hospital stay so your patient is out in two days as opposed to 10, and they do not need to go to intensive care or high dependency."

In 1948, the NHS had some support available for those with hearing problems such as special schools, sign language and even cumbersome hearing aids.

Over the past 20 years, however, an increasing number of patients have benefited from a surgical innovation.

"Cochlear implantation - surgically implanting a device to directly stimulate the inner ear - is the greatest ever advance in the treatment of profound deafness and has transformed the lives of thousands of adults and children worldwide," said Richard Ramsden, president of ENT UK.

Douglas McGeorge, president of the British Association of Aesthetic Surgeons, said the advent of new man made materials such as silicone for breast implants had enabled dramatic advances.

" It means that we can rejuvenate breasts we can give people who have been born with very little breast tissue normal breasts."

Bernard Ribeiro, president of Royal College of Surgeons, summed up the revolution that has taken place.

He said: "Over the last 60 years surgery has transformed almost out of all recognition.

"A patient in 1948 would have almost certainly been treated by a general surgeon covering a wide range of specialties in surgery and could expect a lengthy hospital stay.

"Today, advances have led to much greater degree of specialisation and, as shown by this snapshot of our members, led to sophisticated treatments for previously incurable conditions, better quality of life and shorter hospital stays."quote>

[belfastuniguy 18]

In 60 years the NHS has changed dramatically - in terms of what it provides, how it is administered, who works there and how much it costs to run.

Here is an at-a-glance look at some of the changes.

LIFE EXPECTANCY

INFANT MORTALITY

SMOKING

VACCINATIONS

CHIEF CAUSES OF DEATH

PRINCIPAL KILLERS

Main causes of death in 1948 and how they compare now

(2006 except where stated)

England and Wales	THEN	NOW	Scotland	THEN	NOW
Heart and circulatory disease	35.4%	34.6%	Heart disease	42.8%	33.2%
Cancer	16.9%	27%	Circulatory disorders	28%	16.6%
Stroke	11.5%	9.6%	Cancer	13.7%	27.2%
Bronchitis or respiratory diseases	10.4%	4.6%	Tuberculosis (TB)	6.2%	0.08%
Tuberculosis (TB)	4.7%	0.7%*	Scotland categorises some causes of heart disease differently from England and Wales Northen Ireland data unavailable

quote>

In 60 years, the NHS has burgeoned into one of the biggest employers in the world, with well over a million people working for it.

NURSES

GPs

HOSPITAL CONSULTANTS

quote>

The NHS in numbers: Then and now

• Health
• Finance
• Staff

The National Health Service has evolved over its 60 years into a complex multi-billion-pound business, funded by a combination of taxation and direct payment.

The overall NHS budget has grown by a factor of about 375 in that period.

However, in real terms, the increase is approximately 16 and a half times the 1948 amount.

Meanwhile, the cost of prescriptions in England is now about seven times the original charge, introduced in 1952 (in real terms).

The Welsh national assembly scrapped charges in Wales in 2007.

And in Scotland the charge is being phased out by 2011.

The situation in Northern Ireland is under review.quote>

 

Does the NHS have a future?

By Mark Easton Home editor, BBC News

Continued universal free access to care is in doubt

The simplicity of the National Health Service idea has survived the complexity of extraordinary medical progress.

Universal, funded from taxation and free at the point of need - these are phrases which Health Secretaries have reiterated for six decades, the principles which underpin the NHS.

The British public loves its health service, but can it survive another 60 years?

Can a system of free medical care for all be maintained in the face of new and expensive treatments, and with a population becoming ever more knowledgeable and more demanding?

Some doctors argue that the traditional NHS is doomed because the state cannot afford to fund an ever increasing array of drugs and procedures.

The future has to be about a tax-based system that is a core package that is reasonable and everybody accesses it - but if you want to have some luxury items, you top-up Professor Karol Sikora Cancer Partners UK

Physicians like cancer specialist Dr Karol Sikora argue that the result will be a two tier service.

He said: "The future has to be about a tax-based system that is a core package that is reasonable and everybody accesses it - but if you want to have some luxury items, you top-up."

It is a vision that has sent shudders through government.

Alan Johnson, the Health Secretary for England, attempted to outlaw such top-ups by ruling that any patient who bought additional care or drugs privately would be denied NHS treatment for their condition.

The papers were filled with stories of patients who had spent their life-savings on drugs the health service refused to provide and who were then advised that their NHS treatment was being withdrawn.

In a statement to Parliament, Mr Johnson said: "A founding principle of the NHS . . . is that someone is either a private patient or an NHS patient."

It proved a desperate attempt to hold back the tide and last week he dropped the policy in favour of a formal consultation on the matter.

However, it is an issue that will have to be faced.

Drug company pressure

Drugs companies like Roche UK are knocking on the doors of the advisory bodies which regulate the availability of drugs on the NHS, calling on them to give their products the green light.

It's really a moral decision, whether as a society we decide we want to stay in all this together or we want start going our own ways Niall Dickson King's Fund

"There will be changes in the overall drugs budget within the NHS," said Julian Cole from Roche.

"Money can be released from elsewhere within the health service to actually fund many of these drugs.

"They are cost-effective, providing good value for money and so if there is a will to provide that funding then it will follow."

But if the NHS did agree to fund any drug for which there was demand, how much more would it cost?

As Medical Director of the private healthcare company Cancer Partners UK, Dr Sikora has calculated that if the NHS agreed to fund ten cancer drugs currently unavailable it would push the bill up by almost £0.9 billion.

The government believes it is a lot less, but no-one denies that protecting the principles of the NHS will mean spending significantly more.

Public will

The independent health think tank The King's Fund, though, argues that recent history demonstrates that voters will pay more to protect the health service.

Niall Dickson, the chief executive, is confident that a tax funded universal system can be afforded.

FIND OUT MORE As the NHS turns 60, BBC News is giving it a health check. Watch out for reports, features and analysis on TV, radio and the web.

"It's really a moral decision, whether as a society we decide we want to stay in all this together or we want start going our own ways," Dickson believes.

"There is no sign yet that the British people want to go their own way."

As the great and the good gathered this afternoon at Westminster Abbey to celebrate sixty years of the NHS, it is clear the service stands at a crossroads.

We face a choice: a health service that limits its ambition to providing good enough care.

Or a genuinely universal system that costs a lot more but is true to its principles.

The path we choose will depend on how much we think that simple original idea is worth.quote>

BBC SPECIAL ON THE NHS AT 60

 

[Duke87 1,070]

Happy 60th birthday, nanny state!

[belfastuniguy 18]

The NHS is not a state!

Its an organisation

However, on that issue.

Also I do not wish to see this turn into a bash the United Kingdom or NHS thread, constructive and VALID criticism and debate is welcome, not conservative or mis-informed rubbish.

Public tolerant of 'nanny state'

The public are not opposed to the state interfering in their lives to get them to become healthier, a BBC polls shows.

The government has been accused of acting like a nanny state in the past over some of its public health initiatives.

But the survey of 1,040 people in the UK revealed most wanted ministers to take more responsibility for getting people to make healthier choices.

It comes amid increasing problems with binge drinking and obesity.

Alcohol consumption has been rising steadily for the past 15 years, with figures suggesting a third of men and a fifth of women drink more than the recommended levels each week.

And alcohol-related deaths have more than doubled since 1991 to over 8,700 a year.

Meanwhile, nearly a quarter of adults are obese - up 50% in the last 10 years, while one in six children aged two to 15 are classed as obese - up from one in 10.

The poll, carried out by ICM Research for the BBC, showed that 82% wanted the government to take more responsibility for getting people off illegal drugs.

Meanwhile, 69% were prepared for the government to be more active in reducing drinking rates and encouraging healthy eating.

Some 67% said more should be done to get people to give up smoking - despite falling rates and the introduction of smoking bans throughout the UK.

And 65% said ministers should do more to get people to lose weight.

But the public were also not tolerant when asked if people should be entitled to free treatment if they continued leading unhealthy lifestyles.

Just 51% said alcoholics should be entitled to free NHS treatment when attending A&E for a drink-related problem, while 64% said smokers should get lung cancer care.

Earlier, the BBC reported other findings of the poll, showing infections were the biggest fear about hospital treatment.

FINDINGS IN DETAIL BBC/ICM NHS survey [66KB] Most computers will open this document automatically, but you may need Adobe Reader Download the reader here Infections 'biggest fear'

Nonetheless, eight in 10 said they were proud of the NHS.

Dr Hamish Meldrum, chairman of the British Medical Association, said it was clear the NHS had a responsibility to help patients whose heath had been damaged by bad lifestyle choices.

However, he added: "People also have a responsibility for their own health.

"There will never be a "pill for every ill" and the health service will only cope if members of the public do their bit in terms of diet, exercise and alcohol."

Professor John Appleby, chief economist at the independent think tank The King's Fund said more funds would inevitably be required to meet growing public expectations of the role of the NHS.

He said: "We could be looking at growth in spending over the next 20 to 30 years taking us up to one pound in five in the entire economy. That would fit with trends in other countries."

FIND OUT MORE As the NHS turns 60, BBC News is giving it a health check. Watch out for reports, features and analysis on TV, radio and the web.

The BBC poll also found that the most common concern about hospital care was the risk of acquiring an infection, such as MRSA or Clostridium difficile.

Four out of ten people surveyed listed the risk of infection as their biggest fear.

However, 82% of respondants said they were proud of the health service, with half saying it was the envy of the world.quote>

News Link

[Duke87 1,070]

The public are not opposed to the state interfering in their lives to get them to become healthier, a BBC polls shows.quote>

...

Okay, let me repeat the first part of that again:

The public are not opposed to the state interfering in their livesquote>

Wow. That's just scary.

Because let my tell you, I am very opposed to the state interfering in my life.

[hamsterTK 93]

How are counseling programs part of a "nanny state"?

Anyways I know 10 years down the road my parents who are in their 50's and very overweight will really need some push to get healthier if they want to make it to 70.Those self-help programs if offered here would be great for them. I can't do anything about it now because they see me as their 20 year old little kid and won't listen when I say we need to stop eating things.

[Easy Bakes 253]

A lot has changed in 60 years.

Not sure if  it proves if Nationalized health care is better or worse then private.

Or just a general improvement in health care in industrialized nations over the past 60 years.

[sedimenjerry 1]

OH MY GOSH THE UK SUCKS

no im kidding

hamsterTK- may i suggest slowly removing food items from their pantry? i dont mean steal and eat it but hide it. the junk food that is.

[hym 358]

So the NHS is supposed to shift focus from quantity to quality? Doesn't that validate the argument that socialized medicine expands coverage at the expense of the quality? And that it's ultimately unsustainable? (Note: I'm not opposed to everyone getting decent healthcare. I just don't think social programs are the proper route.)

not conservative or mis-informed rubbish. quote>

Could you clarify that comment? I understand the part about misinformation, but the conservative part is leaving me confused (but then, it is 2AM here). I admit I'm probably interpreting the statement wrongly, but it sounds like you're saying my earlier comment isn't allowed since it's the typical "conservative" viewpoint on the issue.

[JanYpe 17]

Originally posted by: hym

not conservative or mis-informed rubbish. quote>

Could you clarify that comment? I understand the part about misinformation, but the conservative part is leaving me confused (but then, it is 2AM here). I admit I'm probably interpreting the statement wrongly, but it sounds like you're saying my earlier comment isn't allowed since it's the typical "conservative" viewpoint on the issue.quote>

I think he was mainly talking about the kind of thing Duke87 has made a headstart with. Comments of the groundless paranoid navel-gazing variety.

[TheQuiltedLlama 34]

Originally posted by: Duke87 Happy 60th birthday, nanny state!quote>

You can say what you like, but the fact remains that for any political party in the UK to advocate the abolition of the NHS would be immediate political suicide.

Originally posted by: hym So the NHS is supposed to shift focus from quantity to quality? Doesn't that validate the argument that socialized medicine expands coverage at the expense of the quality? And that it's ultimately unsustainable? (Note: I'm not opposed to everyone getting decent healthcare. I just don't think social programs are the proper route.)quote>

Bare in mind that it is still possible to get private health insurance in the UK. This means those willing to pay more can still get higher quality care if they feel that the NHS isn't good enough. But I think most people, although it isn't perfect, are happy enough with the NHS.

[Boggy1 45]

Wait, I am slightly confused here. How does a Nationalized Health Service mean that we live in a nanny state? Duke, I really am surprised at you. Aren't you the person who always advocated that correlation does not equate causation?

Again, this is the whole cultural difference of the US being absolutely terrified to the point of hysteria of the Government, whereas most of the world trusts their Government, because, you know, the people elected them....it'll be a sad day when the ordinary person cannot trust their own Government.

Anyway, happy birthday NHS! I'd just like to take a moment to say that the NHS was first thought up by a Welshman

Our Health Service might not be perfect, but its free and provides a very good quality of care!

[Voar Tok 4]

Well, I don't have much to say on the subject since I don't deal with the NHS, but Happy Birthday I suppose.

I would like to clarify one thing though that was mentioned here.

Originally posted by: Boggy1

Again, this is the whole cultural difference of the US being absolutely terrified to the point of hysteria of the Government, whereas most of the world trusts their Government, because, you know, the people elected them....it'll be a sad day when the ordinary person cannot trust their own Government.quote>

The average American is not in a state of hysterical distrust of the government.  Not even close.  What we are is adamant in our distrust of the government, and yes, there is a difference between the two.  Is the government elected by the people? Yes, but each individual only votes for three people that are going to be in it, and not the other 432.  On top of that, the average American remains cautiously aware that once elected, a politician can easily go look after their own interests and their constituents get whatever time is left over.  The idea of a corrupt politician is something we're well acquainted with, especially since this country was founded because of the fallout we had with one (King George III).

And then on top of that, we have two entirely different views on what government exists for.  The average European (based on the structure of the average European government) could be assumed to believe that the government is there to provide for the well-being of the people.  The average American believes that the government is there to provide basic needs like safety and infrastructure, and after that, you're to take care of yourself.

Anyway, I wanted to clarify that.  I now return you to your regular discussion.

[belfastuniguy 18]

I think he was mainly talking about the kind of thing Duke87 has made a headstart with. Comments of the groundless paranoid navel-gazing variety.quote>

Indeed I was.

Wait, I am slightly confused here. How does a Nationalized Health Service mean that we live in a nanny state? Dukequote>

It doesn't, again we just had an example of the typical paranoia many Americans have toward their government. Many distrust it for whatever reason/s they hold. I can see the point as American politicians really only seem to serve themselves and not attempting to address wider issues that effect the country. But due to the systems America has in place they like to focus on small issues specific to their local population. Of course you have exceptions to this, but in general that seems to be the case.

Yes the NHS is not perfect, then again nothing else whether public or private. I think its fantastic you can go into a hospital and be treated with equipment would tens of millions, have an operation costing thousands and then all your after-care and end up not paying a penny above your normal tax and national insurance payments. Obviously there are going to be availability issues given the monumental cost involved in providing a modern public health service, but it remains free at the point of use.

For those that wish to have it they can avail of private healthcare, no one denies them that right, however to deny another person the basic right to decent and modern healthcare when in need is a disgrace. Some argue its not a right, we've seen this debate before and it tends again to be Americans. The culture in the UK and Europe is different. We don't see our governments as dishonest and corrupt. We expect them to ensure we are cared for from cradle to grave. Why shouldn't we? We pay our taxes and we contribute to the overall economic development and prosperity of the country.

I use private healthcare, but have also used the NHS and every time I have I have had no complaints. Its a fantastic institution and something the British people are proud of, yes there are of course problems, there would be in an organisation that size and for decades run centrally. This is now changing and the picture is different across the countries of the United Kingdom. I'm not sure how it will look in another 60 years, but basic care I believe will always remain free at point of use as well emergency and vital operations.

Many Americans may praise their own service, however it is deeply flawed. The costs of American healthcare are absolutely ridiculous. There was a recent article by a FOX Journalist (yeah I know FOX, but the article was actually very good) he was describing how while in the UK his wife suffered a stroke and went on to detail the treatment she had here and what would happen when she returned to the United States. However was struck me was the high cost of American healthcare, the bill he received (foreigners have to pay) was about $25,000, this was was MRI scans, a month of treatment in hospital, physical therapy and numerous tests. The journalist then compared that with the costs for 10 physical therapy sessions at New York's Cornell University Hospital which amounted to $27,000. One of the biggest problems he detailed with the American thirst for ligation as well as there being no desire to control or limits costs.

While American hospitals are fantastic and benefit much greater funding than British hospitals I would much rather have our system where no matter who you are you receive the best treatment possible. People who have an image of old or decaying hospitals should actually come and visit some of our newest or redeveloped hospitals, they are clean, modern and filled with the most up-to-date medical equipment possible. NHS hospitals suffered a chronic lack of investment in the 1980's and early 1990's, that has all changed and you can see the difference.

People need to actually look at the system in detail before making such quick and clearly flawed arguements.

[Barbarossa 51]

.

  Edited September 7, 2012 by Barbarossa  

[belfastuniguy 18]

Perhaps this is off-topic, but am I the only one who noticed in belfastuniguy's second posting that cancer deaths have actually increased by 10% points since 1948? Obviously the NHS doesn't have anything to do with that, but it is a remarkable statistic. Does anyone have an idea why? Personally, I contribute it to increased pollution (particularly in metropolitan areas), as well as processed foods/pesticides and, perhaps, a higher prevalence of manufactured products (think pthalates). quote>

I think that's mainly due to the fact we know more about cancer and as we discovered new types of cancer, obviously the death rate increased as more people that died where found to have died of cancer. Though your point about lifestyle is also pretty accurate, in particular to eating habits.

[BurroDiablo 222]

Happy be-lated Birthday!

Originally posted by: Duke87

The public are not opposed to the state interfering in their lives to get them to become healthier, a BBC polls shows.quote>

...

Okay, let me repeat the first part of that again:

The public are not opposed to the state interfering in their livesquote>

Wow. That's just scary.

Because let my tell you, I am very opposed to the state interfering in my life.quote>

I acctually don't understand that quote at all... is my life being interfered with? Because if it is, it's barely noticable... in health care at least. I think what they mean is, they don't mind the Government providing healthcare for us, I wouldn't class that as interfering with our lives, its not like government officials kick my door down at night and force me to use a different Asthma inhaler.

[Meg 368]

Originally posted by: Voar Tok

 . . .  And then on top of that, we have two entirely different views on what government exists for.  The average European (based on the structure of the average European government) could be assumed to believe that the government is there to provide for the well-being of the people.  quote>

Which is basically the definition of a "nanny state", where the government takes the point of view that they know what is best for us and will make sure we listen.

The average American believes that the government is there to provide basic needs like safety and infrastructure, and after that, you're to take care of yourself. quote>

Which is what enables us to "be all that we can be".  It is difficult for individuals to excel when the fruits of their labor go to benefit someone they don't even know.  It's discouraging.

Originally posted by: Duke87

The public are not opposed to the state interfering in their livesquote>

Wow. That's just scary.

Because let my tell you, I am very opposed to the state interfering in my life.quote>

I don't see that as paranoid.  I see that as an offshoot of Americans refusing to be considered "subjects" of any government.

Personally, I take a moderate viewpoint on things.  I'm all for the government encouraging certain behaviors and discouraging others.  That is, after all, the (theoretical) purpose of tax incentives.   (which is why I'm opposed to the flat tax, which is a whole different issue and beyond the scope of this thread.)

Originally posted by: Boggy1

Anyway, happy birthday NHS! I'd just like to take a moment to say that the NHS was first thought up by a Welshman

Our Health Service might not be perfect, but its free and provides a very good quality of care!quote>

Well, it's not free; it just doesn't cost anything at the point of delivery.  But I'm glad you are happy with it.  A British friend and I did a detailed comparison of our health care systems and came to the conclusion that neither was perfect; they were just imperfect in different ways.

[confused04 14]

Cancer deaths and diagnoses have also increased in the United States and that has more to do with the fact that people are getting old enough TO GET cancer (after age 50, each subsequent decade has an ever increasing chance of cancer) in addition to our ability to find such cancers.

I'm one American who doesn't buy the "private health care" is better. I think the state should be involved in healthcare as it promotes preventative measures to lower overall expenses. Additionally, private health care has a greater administrative overhead to to the same job as public health care. Yes, the top top health care facilities in the US are unmatchable, but if over 19 in 100 people have no access to any health care, it seems more like an aristocratic privilege than a service. Costs for a public health care system will likely not be significantly larger than a private system due to several reasons, lower administrative oversight (why do some health care providers walk out with 50 million dollars?), greater population pool to decrease risk (insurance coverage benefits from having more subscribers to divide collective risk), preventative measure is far far cheaper than reactive measures. Waiting times are already comparable. Again, I don't advocate for the complete erasure of private health insurance, but what sucks is that as a tax payer, I have often have to pay more due to our lack of preventive medicine in other costs such as unpaid health bills, lost societal productivity and so forth. Really, I too don't trust government... but I'd rather have someone in office that has SOME level of accountability through elections than some massive corporation where big cats walk away with pension plans in the hundreds of millions.

[saltandsauce 0]

that thing is wrong we don't get BCG vaccinations anymore (even though TB is on the rise)

[JanYpe 17]

Originally posted by: SkiGeek

Originally posted by: Voar Tok

 . . .  And then on top of that, we have two entirely different views on what government exists for.  The average European (based on the structure of the average European government) could be assumed to believe that the government is there to provide for the well-being of the people.  quote>

Which is basically the definition of a "nanny state", where the government takes the point of view that they know what is best for us and will make sure we listen.quote>

No. What you give as the definition of a "nanny state" is reasonable enough (the nanny state being an overbearing government), but the way you connect it to VT's post is far too narrow.

 

There are many more steps between a minimal, night watchman government and a full blown nanny state. There are also many varying visions put forward by parties and platforms on how best to use the government. Attaching the pejorative "nanny state" to it and shoving the whole of it aside is as ridiculous as calling every American a gun-toting, redneck zealot.

The average American believes that the government is there to provide basic needs like safety and infrastructure, and after that, you're to take care of yourself. quote>

Which is what enables us to "be all that we can be".quote>

And leaves many standing in the cold, open to exploitation and generally entails just as many negative as it does positive sides.

 

It is difficult for individuals to excel when the fruits of their labor go to benefit someone they don't even know.  It's discouraging.quote>

It's solidarity.

What does it matter whether you know them or not? If, as a piece of paper you should be familiar with suggests, all are created equal and with a right to life, liberty and the pursuit of happiness, then all deserve the same basic amount of respect and support as humans. That simply requires those who can to share the burden for those who cannot.

 I believe it's obvious that those who perform well deserve their reward and that it's important to strive for economic independence for everyone. It is a cornerstone in maintaining an open society where everyone makes their own decisions and decides their own development. I believe it is just as self-evident for everyone to share in the prosperity. Because it is just as important that the highest possible amount of people can take part in the full social and economic process, because this improves the community as a whole.

 There are many different views on how to protect and improve society within these "nanny states". I believe in the own capability for strength and development that people have. I want a government that both supports and leaves space for this innate strength, ingenuity and creativity. It is an irresponsible cop-out to deride the government as if it were an independent entity without the slightest connection to yourself. Society is not other people. Society starts with yourself, so take your responsibilities.

Originally posted by: Duke87

The public are not opposed to the state interfering in their livesquote>

Wow. That's just scary.quote>

Way to take one word and entirely miss the point.

Because let my tell you, I am very opposed to the state interfering in my life.quote>

Well isn't that just special. The rest of us can't wait to have "the state" throw us in chains at every turn. Oh what utter joy and luck you must have to be American, since everything else is clearly so inferior.

Originally posted by: SkiGeekPersonally, I take a moderate viewpoint on things.  I'm all for the government encouraging certain behaviors and discouraging others.  That is, after all, the (theoretical) purpose of tax incentives.   (which is why I'm opposed to the flat tax, which is a whole different issue and beyond the scope of this thread.)quote>

Which is what "the state interfering" actually referred to, before paranoia was applied.

I don't see that as paranoid.  I see that as an offshoot of Americans refusing to be considered "subjects" of any government.quote>

I see it as paranoid to refuse to even try to improve the way we govern ourselves. I see it as paranoid to throw a hissy fit the moment the word government so much as pops up. It has jack-all to do with being the "subjects" of anything. 1776 is long gone, and there's no such thing as subjects since we live in the 21st century instead of a medieval fiefdom.

[toxicpiano 125]

[belfastuniguy 18]

that thing is wrong we don't get BCG vaccinations anymore (even though TB is on the rise)quote>

Because its no longer required. The potential infection transmission rate is so high its no longer cost effective. When the programme was introduced in 1953 94 children would have to be immunised to prevent one case of TB, by 1988, the annual incidence of TB in the UK had fallen so much that 12,000 children would have to immunised to prevent one case of TB. The programme was scaled back in 2005.

The recent increase is in the immigrant population from eastern Europe and Africa and most when they enter the UK will be given the injection as they are deemed a high-risk group.

Also...well said JanYpe

[Duke87 1,070]

Originally posted by: Boggy1 Wait, I am slightly confused here. How does a Nationalized Health Service mean that we live in a nanny state? Duke, I really am surprised at you. Aren't you the person who always advocated that correlation does not equate causation? quote>

What does this have to do with cause and effect versus coincidence?

National socialized healthcare is a very nanny state type thing since it is the government taking care of people as opposed to letting people take care of themselves. The government is being people's "nanny". See?

Again, this is the whole cultural difference of the US being absolutely terrified to the point of hysteria of the Government, whereas most of the world trusts their Government, because, you know, the people elected them....it'll be a sad day when the ordinary person cannot trust their own Government. quote>

True on the first part. There is a major cultural difference at play here. As for not trusting our own government, well, as they say, power corrupts. We just don't trust anyone to be in a position of power (which being part of the government means) without being corrupted by it.

But we've had nasty experiences with that in the past, first and foremost with George III and all that stuff leading up to the Revolution and the Declaration of Independence (which, by the way, was signed 232 years ago tomorrow).

Anyway, happy birthday NHS! I'd just like to take a moment to say that the NHS was first thought up by a Welshman

Our Health Service might not be perfect, but its free and provides a very good quality of care!quote>

Define "free". Sure, you don't pay out of pocket when you go to the doctor, but your taxes are paying for it and therefore ultimately you are paying for it. It's not "free". It can't be. Healthcare costs money and that money can't just be pulled out of thin air.

As for "good quality of care", well, that's debatable. Depends on where you place the bar, really. Generally the bar in America is higher. Difference is, over here a bum off the street can't walk into a doctors office and expect to reach that bar.

Originally posted by: JanYpe

Way to take one word and entirely miss the point.quote>

I see the point as being that people are in favor of the government being their nanny as opposed to having to make their own way in life like mature adults. What do you see it as?

Well isn't that just special. The rest of us can't wait to have "the state" throw us in chains at every turn.quote>

Well, according to the above news story, it would seem that's sorta the case in the UK.

At least from a staunchly libertarian perspective, anyway.

Oh what utter joy and luck you must have to be American, since everything else is clearly so inferior.quote>

Yes, that's right. I say I'm opposed to something and it means I'm looking down my nose at the rest of the world. Exactly which one of us is missing points here?

Originally posted by: SkiGeek Personally, I take a moderate viewpoint on things.  I'm all for the government encouraging certain behaviors and discouraging others.  That is, after all, the (theoretical) purpose of tax incentives.   (which is why I'm opposed to the flat tax, which is a whole different issue and beyond the scope of this thread.)quote>

Which is what "the state interfering" actually referred to, before paranoia was applied.quote>

If that's what it referred to, then it was worded poorly. "Interfere" carries quite a negative connotation. It invokes imagery of control-freaky totalitarian policies, not friendly encouragement. So, let me reword that headline in a way that sounds less negative:

The public is not opposed to the state encouraging them to become healthier, a BBC poll shows.quote>

That seems to portray your perspective more accurately.

Of course, I like it better the way it was, since it's calling a spade a spade: the state interfering in people's lives. How healthy I am is my problem and my problem only.

Besides, I myself prefer to do what makes me happy and feels good, not what might make me live longer. Because the "healthy" stuff isn't as good or as fun as the less healthy stuff. And it seems silly to me to do things which aren't fun when all you're doing is buying yourself time. As the saying goes:

Eat Well. Stay Fit. Die Anyway.

[belfastuniguy 18]

Define "free". Sure, you don't pay out of pocket when you go to the doctor, but your taxes are paying for it and therefore ultimately you are paying for it. It's not "free". It can't be. Healthcare costs money and that money can't just be pulled out of thin air.

As for "good quality of care", well, that's debatable. Depends on where you place the bar, really. Generally the bar in America is higher. Difference is, over here a bum off the street can't walk into a doctors office and expect to reach that bar.quote>

Free at the point of service.

So you can walk into a doctors clinic or hospital and be treated and not have to give your credit card over, have insurance documents or fill out endless forms. You are treated as quickly as possible and when ready sent home. Go into hospital for an operation and again you looked after, given whatever advice required and then taken into surgery.

Obviously its not 'free' no one said it was free, we said free at point of use. Every person in the United Kingdom that works pays their taxes and National Insurance, which despite what some Americans believe are not exorbitant. Some European taxes are, but I think the UK taxation levels are fine.

A person may pay

[Pete06 0]

Happy Birthday NHS, but the question is can we continue with an NHS model that is at best patchy at worst totally inefficient and causing unnecessary deaths. We spend billions on health, the NHS one of the biggest organisations in the world but we still have not got the quality of our healthcare up to the average European level. Its time we look to our European neighbours and copied their system of social insurance.

Copied from http://www.westbromblog.blogspot.com/:

Politicians will go to any length to convince us that we can trust them with the health service, from Blair's "24 hours to save the NHS" to Cameron's "safe in our hands". As the NHS reaches 60 they are clambering over each other to offer policy tit-bits. Some modest structural reform, giving patients a choice of hospital, scrapping targets, introducing patient review tables. None of these will actually address the fundamental failings of the NHS.

There can be no doubt about the scale of the extra resources that Labour have pumped into the NHS over the last 10 years, but it is equally clear that the extra resources have not created a service of the standard of our continental neighbours. We have fewer doctors per head of population than any European country apart from Albania. We import nurses and doctors from the world's poorest countries, and export sick people to some of the richest. By the Government's own estimates, 20 per cent of NHS money is wasted, and it now has more bureaucrats than beds. Its not cheap, its not efficient, it keeps people waiting. One in four cardiac patients die while waiting and one in five lung cancer patients wait so long they go from being treatable to untreatable.

We all recognise these symptoms; we all know the disease - that the NHS is a politically controlled state monopoly that is institutionally unresponsive to the needs of patients - so why do we refuse to accept the cure?

We only have to look to the Netherlands, France, Germany and Switzerland to see what we could have - the best healthcare system in the world through a system of competing but compulsory social insurance schemes that are independent of government, run by employer groups, unions, charities or mutual societies. Premiums that would be proportional to income, making sure the system is as fair as general taxation but allowing ordinary people to see more clearly the connection between the cost and the standard of service they receive. As recently introduced in France, premiums for the poor could be paid out of general taxation ensuring they get access to the same medical services as the rich. In the social insurance system the government need not own and run the hospitals or employ every clinician, mearly be the regulator, making sure the system works efficiently and ensuring the vulnerable are protected. It would be a one-tier system, unlike the NHS where the middle classes queue-jump by going private. As in France, all medical services should be free at the point of use, unless patients choose to pay for services in return for lower premiums.

All eastern European countries had Soviet-style health systems identical to the NHS, delivering equally second-rate care, until the fall of the Berlin Wall. They then opened their minds, and almost all of them, from Poland to Romania, changed to social insurance. Social Insurance is not some right-wing plot to boost profits for insurance companies, but a way to make the health service work in the interests of patients rather than against them. Labours former Health Spokesman, Lord Desai accepts this, as does Labours favourite think-tank, the Institute for Public Policy Research. The public agree that the current NHS system is unsustainable, so what are we still waiting for? For the first time in living memory the public trust the Conservative party with the future of the NHS, why are we still failing to offer them a decent solution? quote>

[belfastuniguy 18]

Happy Birthday NHS, but the question is can we continue with an NHS model that is at best patchy at worst totally inefficient and causing unnecessary deaths. We spend billions on health, the NHS one of the biggest organisations in the world but we still have not got the quality of our healthcare up to the average European level. Its time we look to our European neighbours and copied their system of social insurance. quote>

I disagree. "At best patchy" not sure what hospitals you havem but the ones in my country are far better than patchy. Not perfect but certainly capable of doing the job.

Its not exactly fair to compare the NHS with some European models, as they all have their own differences. There are no insurance schemes in the NHS, no additional funding bar what comes from central government and whatever donations the NHS or individual hospitals are endowed.

The system does need reform, but first we need to lessen the control of central government and put more power into local authorities. This can already be seen in the regional differences between England, Wales, Scotland and Northern Ireland. Each respective NHS body does things a little differently or have different priorities. That works here in Northern Ireland (maybe others from the other regions can educate us regarding their own NHS)

Over here we do not have patchy service, in fact we have some of the best NHS care in the UK in some of the newest and most modern hospitals. Our cancer patients can avail of completely free treatment at one of Europe's leader cancer research and treatment centres, a world class Children's hospital, one of the most advanced brain and spinal injury units in the UK and various other facilities.

That article is a general snapshot of the NHS and does not account for regional variation. Historically the English NHS has fared the worst, but that is also changing. Our standard of care is now actually very close to the European level and in some areas better.

[Meg 368]

Originally posted by: JanYpe

 

There are many more steps between a minimal, night watchman government and a full blown nanny state. There are also many varying visions put forward by parties and platforms on how best to use the government. quote>

Of course.  Very few things are "either/or".  Most issues have a continuum of possibilities in between.   Few things are black or white; there are many shades of gray in between.

The average American believes that the government is there to provide basic needs like safety and infrastructure, and after that, you're to take care of yourself. quote>

Which is what enables us to "be all that we can be".quote>

And leaves many standing in the cold, open to exploitation and generally entails just as many negative as it does positive sides. quote>

There are safety nets to keep people out of the cold and away from exploitation.  No, they do not work perfectly but, as was discussed earlier, nothing does.

 

It is difficult for individuals to excel when the fruits of their labor go to benefit someone they don't even know.  It's discouraging.quote>

It's solidarity.

What does it matter whether you know them or not? If, as a piece of paper you should be familiar with suggests, all are created equal and with a right to life, liberty and the pursuit of happiness, then all deserve the same basic amount of respect and support as humans. That simply requires those who can to share the burden for those who cannot. quote>

Not everyone agrees with that chain of reasoning.   Many believe that people are not "required" to do much of anything.  There is a saying:  "the only things you have to do are pay taxes and die".   and they want to minimize the taxes; the dying part is inevitable.

It is an irresponsible cop-out to deride the government as if it were an independent entity without the slightest connection to yourself. Society is not other people. Society starts with yourself, so take your responsibilities.  quote>

I agree completely, although we might disagree on what those responsibilities are.

Because let my tell you, I am very opposed to the state interfering in my life.quote>

Well isn't that just special. The rest of us can't wait to have "the state" throw us in chains at every turn. Oh what utter joy and luck you must have to be American, since everything else is clearly so inferior.  quote>

  Where did that come from?  I didn't hear him saying that at all.

Originally posted by: SkiGeek

Personally, I take a moderate viewpoint on things.  I'm all for the government encouraging certain behaviors and discouraging others.  That is, after all, the (theoretical) purpose of tax incentives.   (which is why I'm opposed to the flat tax, which is a whole different issue and beyond the scope of this thread.)quote>

Which is what "the state interfering" actually referred to, before paranoia was applied. quote>

Perhaps.  There is a huge difference between "interfering" and "encouraging".  It's one thing to encourage charitable donations by giving people a tax break.  It's another thing to mandate charity by removing the funds from their paycheck.

I don't see that as paranoid.  I see that as an offshoot of Americans refusing to be considered "subjects" of any government.quote>

I see it as paranoid to refuse to even try to improve the way we govern ourselves. I see it as paranoid to throw a hissy fit the moment the word government so much as pops up. quote>

Who was throwing a hissy fit?  I agree with you, though.  I do know people who throw such hissy fits.  It's very unproductive since they can't even pretend to learn anything or to become aware of other points of view.

It has jack-all to do with being the "subjects" of anything. 1776 is long gone, and there's no such thing as subjects since we live in the 21st century instead of a medieval fiefdom. quote>

Let's not pretend that mindset is centuries old.  The term "subject" was in widespread use during my adult years.  I may be older than most people here but I'm hardly medieval. 

  

[hym 358]

Originally posted by: belfastuniguy

Say that person is involved in a road accident and has to go into hospital and get treatment coating tens of thousands....is he/she asked to make up the difference..no.

Lets look at America, yes SOME hospitals are superior, but lets not paint an image that all American healthcare is fabulous and Americans exist in a world of gleaming hospitals and glorious healthcare.

Those that can afford it can avail of some of the best care in the world. Same goes for wealthy people in the UK using private care. Lets take that bum from the street you mentioned.

He's suffered terrible pain, in the great USA he cannot avail of your superior healthcare, so your society confine him to under-funded, under-staffed and decaying social hospitals. In the UK we would not tolerate such a thing, everyone uses the same hospital whether rich or poor and they get the best care possible no matter the time involved or expense. That is what makes this country different to the United States and what makes many many more different to the United States. quote>

That's not totally correct.  The kind of care that "the bum" would get would depend on what kind of care was available in the first place, and the policies of the medical facilities in his general area.  Most hospitals are run by not-for-profit organizations that will do pro-bono work to some level or another.  Two case in point scenarios:

1. MD Anderson Cancer Treatment Center in Houston, Texas is a hospital that focuses on treating rather advanced cancer cases that are sometimes considered untreatable.  The hospital is widely known throughout the medical community, and receives physician referrals from Canada, Mexico, Europe, India, and quite a few other countries.  While it is less common now (because other countries like India have improved their medical care), during the 90's, it was quite common for MD Anderson to receive foreigners seeking treatment for cancers that were untreatable in their own country.  Most of these individuals received free treatment courtesy of the hospital.  In other words, individuals who couldn't pay--and weren't even US citizens--were getting free treatment courtesy of a US hospital.

2. St. John's Mercy, the largest hospital in St. Louis, Missouri, has signs in its hallways and lobbies that read something along the lines of "If you cannot afford the treatment you are receiving here, speak with XYZ in the Finance Department and they will arrange to have the funding provided so you can continue to receive treatment."

How healthy I am is my problem and my problem only. quote>

Not really...say you neglect your health, your employer is not going to be best pleased, nor your family if you had one and lost ur job as a result of your inability to take care of yourself. A sick population has a negative effect on the overall economy and job productivity.

Americans appear to be somewhat paranoid and selfish when it comes to their responsibility in society.quote>

I'm going to agree with Duke here.  It is ultimately not the boss's concern how healthy I am.  If he feels that I am not healthy enough to perform my duties, he is within his right to terminate my employment.  However, ultimately, my health is my concern only, unless it unreasonably affects the well-being of others, such as me having a highly dangerous disease.

[edmonton_stinks 5]

Socialized healthcare only works if it's well managed. In "Sicko," Michael Moore visited an emergency room in Windsor, Ontario, and found that nobody had to wait more than 45 minutes. If you tried that in Calgary, the people you interviewed would ask you what day it was.