What single-payer health care can mean to you

Following is an excerpt from the latest annual report of the UK National Health Service. You should read the issues they face. Cost and adequate resources are at the top of the list. Some of the comments in the report may sound familiar. 

The NHS employs 1.3 million people, workforce constitues half of the cost of services. There is a massive bureauocray including hundreds of boards and agencies at all levels.

Americans wait for appointments as well, but not like mentioned below and most important not when it comes to serious conditions that need care. The average time spent with GP visit in the U.K. is 8-10 minutes. The US average is about double that. 

Managing health care costs and maintaining adequate resources to deliver care is an ongoing challenge everywhere. 

2015-16 has been a challenging year for the NHS and for the wider Departmental Group. In financial terms, the NHS has faced significant pressures in meeting increased demand for services, and at the same time, labour cost – particularly labour headcount, has increased at a higher rate than the demand for services during the year. This has made it increasingly difficult for the Department to stay within overall spending controls.

However, this year has undoubtedly been a challenging one for the NHS. The Department’s overall performance should be viewed in the context of the key challenges facing the health and care system, including:

• demographic change, in particular the challenges of an ageing population;
rising public expectations, particularly over the opportunities presented by new technologies; and
the fiscal challenge of reconciling rising demand with finite resources.

Elective waiting times are monitored against the referral to treatment (RTT) incomplete pathway standard that 92% of patients still waiting to start consultant-led treatment for non-urgent conditions at the end of the month should have been waiting within 18 weeks from referral. The standard was not met in 3 months in 2015-16. The number of clock starts (demand) is estimated to have increased by 5.0% between 2014-15 and 2015-16, whilst the number of completed pathways increased by 3.8% over the same period, with the result that the waiting list continued to grow during 2015-16 to just over 3.5 million at the end of March 2016. The number of patients waiting more than 52 weeks to start treatment also increased, from 413 in April 2015 to 865 in March 2016, despite the ambition that it should be reduced to as close to zero as possible.

Early diagnosis and treatment are crucial to improving survival rates for cancer, and eight cancer waiting time standards cover different elements of the pathway to ensure patients benefit from better access to cancer services.

The standard that 85% of patients begin first treatment within 62 days of urgent GP referral for suspected cancer was not met in 11 months of 2015-16, although there were signs that performance was beginning to recover towards the end of the year. Demand continued to rise, with the number of urgent GP referrals for suspected cancer increasing by 10.9% from 1.5 million in 2014-15 to 1.7 million, and the number of patients on 62 day pathways starting first treatment increasing by 5.9% from 129,000 in 2014-15 to 136,000 in 2015-16. Delays in diagnostic tests, especially in endoscopic procedures, also added to the pressures in delivering the 62 day standard. The first cohort of an additional 200 non- medical endoscopists funded by HEE began training in January 2016, and will significantly increase endoscopy capacity to support improvement in diagnostic test and cancer waiting times.

The standard that 96% of patients should begin first treatment within 31 days of a decision to treat also includes patients who are not referred urgently by their GP but whose cancer is diagnosed in emergency or other contexts. It was met in every month of 2015-16, as were the other standards with a few exceptions. 

The standard that 93% of patients should be seen by a cancer specialist within a maximum of two weeks from urgent GP referral where cancer is suspected was missed in April 2015, and the standard that 93% of patients should be seen by a specialist within a maximum of two weeks from referral for investigation of breast symptoms, even if cancer is not initially suspected, was missed in seven months of the year.

Source: Report to the House of Commons, Department of Health
Annual Report and Accounts 2015-16


6 replies »

  1. You are confusing single payer with single provider. UK is single provider. Medicare is not. That is why Medicare works so much better. One can have single payer but not single provider which is what Medicare is. The comparisons to delays and other problems of the UK are not apt for that reason. Not that Medicare does not need some review but it is much better conceptually and the proof is in how well it works. Medicare for all with some tweaks is the way forward in my opinion.


    • I’m not really, I understand the difference, but extending Medicare as we know it cannot be done. It would have to look a lot different. Consider that today to work Medicare supplemental coverage is necessary as is Rx coverage. Those with Medicare today pay in total premiums what is considered unaffordable for people on Obamacare with the same income. In addition, to function today Medicare pays below market fees high is only viable because the private sector pays more. Finally, Medicare for all would have to over a whole range of services that Medicare doesn’t. The system would quickly be faced with any of the same issues a the U.K. and others.


    • The UK is a single provider and a single payer system, just like the VA is to our veterans. The national average wait time for our US veterans is that 5.86% have to wait more than 30 days for an appointment. 1.33% of all veterans have to wait between 61 to 120 days for an appointment. The UK has a standard of 96% for 30 days and both the UK and the US VA miss that mark. Either way the VA and the UK model are close to be the same and show the same results.

      It must be remembered that the data that is available on the Internet does not explain the why it takes longer than 30 days. Maybe the vet can’t make the appointment when offered or maybe there are no time slots available. Local VA hospitals have 0% to a high of 13.46% 30-day wait times for the week ending of 6/15/17.

      VA Hospital administrators in the past have also gotten in trouble for faking the data.

      If the government cannot handle a few million vets, how are they going to handle 250+ million people?


      • I do not believe anyone is suggesting single provider (like the VA or UK) for the USA. All the discussions are single payer, multiple provider which is what Medicare and Obama Care are. So the comparisons to the UK and VA are not applicable to the current political discussions.

        Medicare works very well. Ask any Medicare recipient. Our costs for an F Medicare supplement is only $45 per month for excellent coverage (with a deductible) and our Part D drug coverage is $17 a month. We also pay for Part B coverage of Medicare. We know others who pay much much more, but we do not think that is necessary. We would have no problem paying more if it meant everyone had similar coverage.

        On waiting time for appointments, for my cardiologist (and I have had more than one) it does commonly take more than 30 days for a routine appointment to be scheduled. That has nothing to do with the insurance, just that they are busy. As they are routine appointments, that is not really a problem either. For emergencies they make exceptions and see you right away. I also often communicate with the cardiologist on minor issues by website which avoids delays and is efficient.

        For our family doctor it is next day or sometimes same day as she takes no advance appointments, Just sign in on her computer calendar. I do not think wait times in a multiple provider system are a gauge of anything as you can go to a different doctor if it is really a problem.

        I think the statistics about delay are the problem of a single provider system which is very rigid, but NO ONE is suggesting that for the USA. I do not understand even why there is a VA, at least for older people. Why are they not just on Medicare where they will get good service?


      • I think you miss the point. Medicare trust is going broke. Most people pay $150 to $200 a month for a supplemental plan and Part D is typically $35 or more a month for a total of over $500 for a couple. I don’t know where you live, but you have a bargain. Again, you can’t look at Medicare today and apply that to the entire population. The U.K. Is less expensive because they control access, resources and prices. How do you think the US with Medicare for all would control rising costs?


    • In my area, due to Obamacare and many other factors, we went from many hospitals to two corporate hospital chains in the past 8-9 years. The doctors offices are being bought out by one or the other mostly because the admin staffs are 3-4 times bigger than the medical staff. Who would have thought that a doctor would need IT support around the clock? In some counties where I live only one hospital corporate chain now serves that area and one county is about to lose their only hospital. My point is just like a HMO, when we end up with a single payer, they will tell you who you can see and we will end up with a single provider. Currently medicare is not accepted by all doctors but most do accept medicare because they need the revenue stream so once there is a single payer you may have a choice of doctors but the administrative accountants will ensure that their doctors always have a backlog of patients just like how the airline overbook their flights. You can’t lose money because a patient is a no show so overbook the appointments.


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