NHS Propaganda

[The Prof]

So this is very slightly off-topic, but if you consider health to be vaguely science-ish maybe I can get away with it.

As a Brit bewildered by the massive disinformation Americans seems to be getting given about the NHS, can I just ask someone living over there whether the following facts have actually made it through the apparent propaganda?

1. We are not "assigned one doctor by the government" and forced to stick with him/her no matter what. (I've got the choice of about ten different surgeries in my catchment area alone, and many of these are group practices with 5-10 docs. I can change docs any time I want if I'm not happy.)
2. Many Brits can and do pay for any sort of private medical procedure they want, if it's not covered by the NHS and they have the means.
3. Many Brits can and do pay for private insurance which covers the above.

So as far as I can see, what we have is something exactly like the American system (points 2 and 3) - plus the added bonus of free health care for most instances - and crucially, for the poor. How can this be construed to be a disadvantage in any way shape or form? Let alone "evil" as some have branded it?

Are the facts getting through, though? Have the initial lies (from Stephen Hawking being American all the way up through falsehoods about 1-3) been corrected in the media. If so, do people believe the rebuttals?

And maybe you can tell me if what I've heard about the American system are true: if you get in an accident, the hospital won't admit you until you produce evidence of insurance or failing that, they swipe your credit card and confirm you can pay? I.e. that they'd let you die right there if not? To me, that sounds a lot more evil than free -- not perfect, but not too damned bad -- health care for all regardless of wealth.

Finally, what's with the knee-jerk reaction against anything that seems 'socialised'? The term sounds like it has a loaded meaning, historically. And doesn't America have some socialised medicine, for the elderly, already?

[tideliar]

So this is very slightly off-topic, but if you consider health to be vaguely science-ish maybe I can get away with it.

As a Brit bewildered by the massive disinformation Americans seems to be getting given about the NHS, can I just ask someone living over there whether the following facts have actually made it through the apparent propaganda?

1. We are not "assigned one doctor by the government" and forced to stick with him/her no matter what. (I've got the choice of about ten different surgeries in my catchment area alone, and many of these are group practices with 5-10 docs. I can change docs any time I want if I'm not happy.)
2. Many Brits can and do pay for any sort of private medical procedure they want, if it's not covered by the NHS and they have the means.
3. Many Brits can and do pay for private insurance which covers the above.

It doesn't matter how many times I point out #2 & #3 it is ignored/falls on deaf ears. Even to people who are pro-"socialised" healthcare...those who are now starting to take on the glazed look of zealots, it is ignored.

So as far as I can see, what we have is something exactly like the American system (points 2 and 3) - plus the added bonus of free health care for most instances - and crucially, for the poor. How can this be construed to be a disadvantage in any way shape or form? Let alone "evil" as some have branded it?

I wish I understood the anti-healthcare reform rhetoric, then I could answer. There is so mutter bullshit being broadcast by the "right" at the moment, and 99% of it is nonsense, literal, rubbish. The other 1% is so distorted it makes no sense.

Are the facts getting through, though? Have the initial lies (from Stephen Hawking being American all the way up through falsehoods about 1-3) been corrected in the media. If so, do people believe the rebuttals?

Ha hahahahaaa, oh, you jest. Surely you jest! Rebuttal? the media assumes, rightly or wrongly, that the attention span of your avg. viewer is about 15mins. there's no time for rebuttal or correction. Anyway, advertisers want sales, not corrections.

And maybe you can tell me if what I've heard about the American system are true: if you get in an accident, the hospital won't admit you until you produce evidence of insurance or failing that, they swipe your credit card and confirm you can pay? I.e. that they'd let you die right there if not? To me, that sounds a lot more evil than free -- not perfect, but not too damned bad -- health care for all regardless of wealth.

not quite that bad, but close. You'll get stabilised and moved to a county hospital. traditionally these are so overwhelmed the average standard of care is lower.

Finally, what's with the knee-jerk reaction against anything that seems 'socialised'? The term sounds like it has a loaded meaning, historically. And doesn't America have some socialised medicine, for the elderly, already?

It is reaching fever pitch with some rightwing commentators openly calling for armed insurrection & revolt. Rush Limbaugh, amongst others, has begun comparing heathcare reform to the practices of Nazi Germany. He is the most listened to voicepiece of the Republican neocon movement, and a deity to most of his listeners. Armed citizenry have begun arriving at the "town hall" meetings where the President is speaking. Last week more than a dozen automatic weapon toting people turned up at one rally.

people are equating the "socialisation" of healthcare with the loss of all civil and constitutional rights: "If he's going to take away my right to choose my doctor, next he'll take my guns."

I genuinly fear for the immediate future. In typical fashion the Democrats are being a toothless weakling and allowing these things to go unhindered in the name of open-discourse and Free Speech.

I would be preapred to lay money on some form of assassination attempt in the next few weeks, as well as a "Kent State Massacre" style shootout at one of these rallys very soon.

If it does happen, I'm leaving.

[Beatrice]

Bloody hell. It sounds like China, except they don't have the excuse of having a media and internet lock-down.

But what about the more intelligent press - New York Times, that sort of thing? Surely some journalist has worked out that it's propaganda -if anything because it makes a good story to say that the Republicans have it wrong?

[challenge]

So as far as I can see, what we have is something exactly like the American system (points 2 and 3) - plus the added bonus of free health care for most instances - and crucially, for the poor. How can this be construed to be a disadvantage in any way shape or form? Let alone "evil" as some have branded it?

Finally, what's with the knee-jerk reaction against anything that seems 'socialised'? The term sounds like it has a loaded meaning, historically. And doesn't America have some socialised medicine, for the elderly, already?

To start, everything that is "socialised" is often interpreted as "communism" (albeit communism light) or more openly "THEY [government/others] will take your money and give them to someone else*". *the rest of the sentence is as follows "...you will not be in control of your own money anymore, or your decisions, but someone else will make them for you". And as everyone knows, the Governement isn't good at finances so they can't be trusted with your money. (they don't really have a stellar record... )

In fairness though, I have to say that some of the Lies that are spread make it really hard to even have a discussion. Last week it was a rumour that 'socalised healthcare will leed to more eutanasia' [since that saves money....]. you can't argue since it is not true but it takes up half of the town meeting from scare elderly people who don't want to give up their right to live...

In short, I think the main thing is this. America has a long standing record of being more "individual" and the solutions for health care, school and other things (maternity leave etc) has always been "for each one on their own account" and the rich people like it. The middle class, up until now, has managed to make it work - partly because of one person income supports a family, partly because health care wasn't as expensive as now. Now health care is expensive, people are without insurence in an alarming rate - at least if you look at self employed people and young ones (19-25 in college) and hourly paid people who don't get access to decent rates. It is also getting increasingly hard to be a single income family (and if you want to put kids through a decent school and college it is even harder.)

However, most people are very hesitant of including everyone in a health care program since it means the money has to come from somewhere(someone). And the ones who has - don't always want to give. Especially not when it is not clear HOW much it is going to cost, how much worse MY medical options will become (waiting for doctor, being assigned a doctor and taking away freedom) and of course, what types of treatments will be included in this so called health care for all. The last question is a big one in my close vincinity since it is the Bible belt and the conservatives are very concerned that abortions will be covered by their tax dollars. And birth control. (as it is covered in socialised countries like UK and Sweden) It is also the question of paying for "fat people's treatments" when they have made themselves fat, lung cancer for smokers etc..... some of these questions that at least we have started to voice in Sweden the last couple of years (since our system needs an overhaul due to shortage of money).

Overall, I think it is maily because people don't know what the bottom line will be and that it feels like an enourmous change that for most voting people (middleclass and up) might not gain anything from. And change is a hard sell, since you don't know what you get.

A somewhat more nuanced person might ask why they can't start with the Medicare project/Other types of inclusive care and see why those rules can't be applied to this new system. Then of course, don't rule out that the medical industry in the US is something like the third sector moneywise - the insurance companies don't necessarily don't like this reform and maybe that is something that shows?? [it's not paranoia if it is true]

[Reg_200]

Challenge is right. It's the red-pinko taint. But I think a lot of people don't realize that they are already supporting society in this way, bigtime - when they pay taxes, when they contribute to social security and workman's comp. It's all in the spin.

[amy c.]

So this is very slightly off-topic, but if you consider health to be vaguely science-ish maybe I can get away with it.

As a Brit bewildered by the massive disinformation Americans seems to be getting given about the NHS, can I just ask someone living over there whether the following facts have actually made it through the apparent propaganda?

1. We are not "assigned one doctor by the government" and forced to stick with him/her no matter what. (I've got the choice of about ten different surgeries in my catchment area alone, and many of these are group practices with 5-10 docs. I can change docs any time I want if I'm not happy.)
2. Many Brits can and do pay for any sort of private medical procedure they want, if it's not covered by the NHS and they have the means.
3. Many Brits can and do pay for private insurance which covers the above.

Short answer: No. You live in furrinerland. Nobody knows how your system works. There's some (some) familiarity with Canadian health.

And maybe you can tell me if what I've heard about the American system are true: if you get in an accident, the hospital won't admit you until you produce evidence of insurance or failing that, they swipe your credit card and confirm you can pay? I.e. that they'd let you die right there if not? To me, that sounds a lot more evil than free -- not perfect, but not too damned bad -- health care for all regardless of wealth.

This is true of private hospitals (the not treating part, not the dying part -- they'll send the ambulance to a public hospital). Public hospitals must admit and treat you, and in practice, if you've no insurance, they'll write off most of the charge and put you on a payment plan for the rest. In much of the country, that's fine; in some parts, though, you don't want to be anywhere near a public hospital.

So as far as I can see, what we have is something exactly like the American system (points 2 and 3) - plus the added bonus of free health care for most instances - and crucially, for the poor. How can this be construed to be a disadvantage in any way shape or form? Let alone "evil" as some have branded it?

Where do I start.

There are several problems here:
1. The first problem is how to pay for it. Austan Goolsbee's assertions to the contrary, we're bust and living on reputation and other people's need. We're $50T in the hole and we haven't made a dime, net, on trade in decades. (I'm curious to see if we remember how to do that.) We've also got a quarter of the population set to retire and get on public health, and we already know that we can't pay for what we've promised them. Obama knows he can't tax middle-class people much for (more) healthcare for the poor (who are already eligible for Medicaid, Medicaid-like programs for people who don't qualify for Medicaid, and S-CHIP, the children's program). And yet it'll be expensive and someone must pay.

The problem at the bottom of this is that we also expect tremendous healthcare service. We really do. We medicalize everything that moves, people expect immediate care, and we routinely go to heroics. There's no QALY system here; if you're 92 and want a knee replacement, off you go then and don't forget to do your physical therapy. Having a baby? Welcome to your birthing palace complete with spa bath and medical team of 8. We've also got an increasingly unhealthy population thanks in large measure to lifestyle and food-industry problems. Yes, there's waste, but medicine here is expensive for a reason.

2. This is an enormous country which isn't properly a single country at all, and attempting to administer anything over the whole shebang is a nightmare. We have vast empty tracts where people fly instead of drive to the grocery store. And it's not just the West that's rural; I've stayed in places in Vermont where the nearest doctor -- forget hospital -- was a two-hour drive through mountains. In rural Pennsylvania, my dad's only been able to get internet service in the last year or so. So we've got all these very rural places, and then we've got megalopoli with nightmare city hospitals where people really do die in the waiting rooms and people with Medicaid cards are treated like scum (in part because the hospitals lose money on Medicaid -- the reimbursements are too low). Attempting to roll out a healthcare net that actually makes sense nationwide is not only not trivial, it's...I wouldn't want to be involved with trying to implement it.

3. We are not a social democracy and, frankly, suck at making social welfare programs run successfully. It's one thing if you've got national health as part of a network of other welfare-state supports like college grants and flats and pensions you can actually live on. But here...well, here's an example.

My daughter's actually eligible for S-CHIP, the state-administered children's health insurance program; I'm poor enough. Would've cost me $10/mo instead of $150/mo for her usual insurance, on top of $450/mo for mine. I checked it out and determined that S-CHIP here is so poorly administered that I could well end up on the hook for some very large medical expenses. And I might not know until after my daughter was treated, because the mode of local hospitals is to do whatever is necessary and bill later, not to stop in the middle and say, "By the way, your insurance doesn't cover this, would you like for us to go ahead anyway and here's the cost." If I had nothing to lose, that might not matter, but I live in a country where a bachelor's degree costs $80-200K and you're expected to fund your own retirement. I have a college fund for my daughter, and retirement and income-property assets. I don't want to expose them to the risk bad insurance entails. So I passed on the S-CHIP and continue to pay for very good private insurance.

Medicare gets around this by promoting "on top of" coverage called Medigap, which is sold by private insurers and is rather expensive. There is no "S-CHIP-gap" insurance.

Finally, what's with the knee-jerk reaction against anything that seems 'socialised'? The term sounds like it has a loaded meaning, historically. And doesn't America have some socialised medicine, for the elderly, already?

Yes, we do have socialized medicine for the elderly, and it's hitting a brick wall. It made sense when the working:retired ratio was 6:1 and people spent a few years retired, then died relatively inexpensively. Now we're looking at a working:retired ratio that's more like 2:1, and people stay on Medicare for 30 years, then die in hospital, expensively. There was also tremendous resistance to Medicare when it first came in, incidentally, in the 60s. People wouldn't take it. Wouldn't sign up. Said they hadn't asked for a handout and were damned if they'd take one. I understand the sentiment. As a poor single mother, I get back-door welfare in the form of the Earned Income Credit. Thousands annually. I didn't ask for it; I can do without; and I know it's just one more twig tossed up on the pile of national debt. Do I think it's responsible, no.

The knee-jerk against "socialized" has several roots, strongest of which are still Wall Street and the West. One wants to be left alone to practice red-in-tooth-and-claw capitalism; the other just wants to be left alone and finds virtue in taking care of one's own. And then there are the facts that a) we suck at administering these things; b) you will never get the money for free. Somehow, with some liberty not of your choosing, you'll pay.

There, that's a shaving off the iceberg.

[amy c.]

Challenge is right. It's the red-pinko taint. But I think a lot of people don't realize that they are already supporting society in this way, bigtime - when they pay taxes, when they contribute to social security and workman's comp. It's all in the spin.

Reg, we're well aware of the money that goes to FICA (Soc Sec/Medicare). Painfully aware. Why? Because those of us under 55 or so don't believe we'll see a dime of it back. It's no secret that we have no obvious way to pay for SS/Medicare through the boomer wave. We've been sitting on the tracks watching the train approach for 20 years at least. But what can you do? They got the guns.

As for unemployment and workman's comp -- a large part of the workforce is no longer involved in these programs, because we're not "employees" under IRS rules. Independent contractors and other contingent workers are responsible for looking after themselves in hard times.

[challenge]

Amy, I think you said what I tried to say - but much more eloquently

your example of your daughter is a good one on why it is so tricky and hard to either qualify or get stuck in debt after you have gone to the hopspital since they don't ask you during but rather afterwards. I remember the case with the family with twins who ended up in the NICU and after 6 months of intensive care passed away. The parents were left with a huge bill, since their insurance only covered expenses up to 2 millions and the care for the twins was more expensive.... the parents didn't know the maximum, although I am not sure if that wouldn've helped since noone told them that one night in NICU is somewhere around $20 000 [or other costs of treatments that weren't disclosed either].

The problem at the bottom of this is that we also expect tremendous healthcare service. We really do. We medicalize everything that moves, people expect immediate care, and we routinely go to heroics. There's no QALY system here

I never really understood this until I was here. I sort of like it, to a point. But it makes it harder to "socalize" the health care since there is no "waiting list due to priority" as much as it is in other countries where this is the norm. [those countries leave people waiting sometimes more than 12 months for a hip replacement which also pisses people off... so there is not a win to start that system out here in the US is my guess?!]

This is an enormous country which isn't properly a single country at all, and attempting to administer anything over the whole shebang is a nightmare.

I think this can't be stressed enough actually. It is hard to phantom - at least for me - that the US is one country but I need to remind myself that STATES are actually more like countries that I previously thought. sometimes it is easier to explain why so many americans are against the "over all health care plan" by making an example of the EU. Would people be interested in a joint heath care program over the EU? Legislated from Brussles and tax collected to Brussles for it?! [EU is now harmonizing health care between the nations, but that is slightly different since the people pay within thier country and billing will go from country to country and not necessary from people to EUtax to people.]

Yes, we do have socialized medicine for the elderly, and it's hitting a brick wall. It made sense when the working:retired ratio was 6:1 and people spent a few years retired, then died relatively inexpensively. Now we're looking at a working:retired ratio that's more like 2:1, and people stay on Medicare for 30 years, then die in hospital, expensively.

This would be the case in many countries (Sweden an example I am most closely related to). The big question is going to be how to solve the payments and at the same time keep the retired people in a good place... I mean, when most systems were implemented the retirement age was the same as now but you only lived for a short amount afterwards. Now we see people being retired for up to 20 years. I love it, but it is going to cost more.

Sometimes I just find myself wondering why I am not terrified of getting old since I will most likely get no pension and have very little money saved (if things look like the last couple of years anyway). Then I remember that I might be hit by a bus tomorrow and I hopefully can make more savings in a real job after post doc... there is that hope thing

My main beef with the health care here in the States is that I find it very hard to argue why children are not covered by a
general health care lagislation. There are tonnes of studies that show that if you get a good healthy start for children the soceity as a whole will benefit from it (think pandemics, obesity, teeth, workforce fitness). I find the statement "everyone has the same opportunities to get somewhere" to be impossible to even start if you don't add "health care for everyone".

[Editor]

I'd like to return to the Prof's original point. He wasn't actually asking why the US doesn't adapt a centralized no-person-left-behind healthcare system - and thanks to a few of you for spelling out the barriers. He was asking about the propaganda, and why the States are branding the system here 'evil'. As an American living in England, I am frankly offended by the lies about the NHS that are being freely disseminated in the States. As a, not starving, but occasionally quite hungry graduate student in Seattle on $13,000 a year with a husband student to support, I have experienced fully the effects of being poor and ill in the United States. A trip to the ER once cost me $1000 -- all I got for this was a saline drip and a Gram stain - which as a TA for the Department of Micro, I could have done myself for about 50 cents. (I thought I had appendicitis. Needless to say the next time I had similar symptoms, I took a calculated risk and did not seek treatment. There must be millions playing that roulette game habitually.)

Contrast that with my experience here. If I feel ill, I can go to the doctor any time, for free. I can go if I'm ill, or I can go just for routine things like cholesterol tests. It doesn't take any longer here to get an appointment than in did in the States - usually within a day or so. If I get in an accident, I can go to any ER and get seen (you have to wait 4-5 hours if you're not a priority, but that's fair enough.) Last year, I had a terrible cancer scare: a huge lump in my breast. The NHS has a two-week rule for cancer: if there is any chance you have it, you are guaranteed to see a consultant within 2 weeks. In my case, I got an appointment with my GP first thing in the morning after discovering the lump. She referred me to a consultant (specialist) at the hospital of my choice. In ten days, I had my appointment: within two hours, I got to see the consultant, then got a mammogram and an ultrasound. It turned out to be a benign cyst, which the SHO ('resident') aspirated right there and then. All *entirely free* from start to finish.

OK, I'll admit those ten days were scary. If I'd been rich, I would have made an appointment in the private clinics in Harley St and had the thing dealt with the morning after I discovered it. The point is, *I could have*. I chose not to because I decided that ten days wouldn't make a difference if I needed chemo.

Last month I developed a terrible infection in the middle of the night. "Terrible infection in the middle of the night" in the US means the ER, and a massive payout. Here, I rang up the 24-hr NHS Direct hotline and was referred to my local night service. Thirty minutes later a cab was dropping me off at the place, and I emerged with antibiotics after another half hour or so. All free. Problem sorted for £30 (return cab fare).

How can anyone call this system 'evil'? Yes, it comes out of my paycheck, but it's not very much per month - maybe a few hundred. It's paid for itself a dozen times over. And I'm relatively affluent - think of all the poor kids who are benefiting. Even if I never went to the doctor, I wouldn't mind chipping in so that others won't suffer. It's basic humanity.

[amy c.]

My main beef with the health care here in the States is that I find it very hard to argue why children are not covered by a
general health care lagislation. There are tonnes of studies that show that if you get a good healthy start for children the soceity as a whole will benefit from it (think pandemics, obesity, teeth, workforce fitness). I find the statement "everyone has the same opportunities to get somewhere" to be impossible to even start if you don't add "health care for everyone".

They are. I think all the states run some sort of S-CHIP program, and there are rafts of other children's health programs to go along with them, plus in-school screenings, free immunization clinics, nutrition programs (of varying quality), and provision of health services. (Dental remains a problem, partly because dental and medical have always been separate here. We now have 20-year-old city people who've never seen a dentist.) All of these are opt-in, though.

Obesity and fitness are special problems, and while I'm not generally in favor of hamstringing whole industries with federal legislation, I'd be very happy to see cap-and-trade for various kinds of food production. Growing tomatoes? Go nuts. Making soft-puff cakey 300-calorie cookies? It'll run ya. But that's a whole nother story.

[amy c.]

Jenny, I should say up front that if you were a grad student here living on a TA's salary, you'd have (very good) university health insurance included in your contract. If you were simply very poor, you'd be on Medicaid or another state program. Most of my writer friends are insured by the state.

I've been poor here for most of 20 years, and often had chronic conditions like asthma to manage. I've seldom had insurance through an employer, because I've seldom been a fulltime employee. I wouldn't call it easy, but if you're willing to read and can do arithmetic (admittedly, this cuts out a large chunk of the population already), you'll do all right. It is crucial, though, to actually read the insurance documents, which are not written in a complicated fashion, but are sometimes long. The twins' parents whom Challenge mentioned didn't do this; right up front in those documents, the insurance co's tell you your lifetime max. They boil it all down into 1-page tables of benefits, too, if you want it that way. And if your lifetime max is inadequate, you must buy a policy to cover catastrophes. I carry a $20M max policy that kicks in if I exhaust my $5M policy; it covers my daughter, too. Costs me about $200/yr.

Despite my raft of pre-existing conditions, I have available to me three affordable group policies and a wide range of individual policies. Rx tends to be covered with medical now, but if it weren't, I'd hop back on one of the pharma "indigent patient" programs where they send you your drugs for free.

I think it's important, though, to keep in mind the difference between insurance and national health. National health treats healthcare as a public service -- a cost, a chunk of the budget -- while insurance is a tool for mitigating private risk. So my very first objection to proposals for national health (subsidized insurance, call it what you will) here is that we're broke. Flat busted. Selling the silver out the back door. With no trade engine that's likely to change that picture anytime soon.

If someone could show me how we were going to pay for this thing without, per Jon Stewart, leprechauns, I'd be more favorably disposed.

[Editor]

Jenny, I should say up front that if you were a grad student here living on a TA's salary, you'd have (very good) university health insurance included in your contract. If you were simply very poor, you'd be on Medicaid or another state program. Most of my writer friends are insured by the state.

When I was a grad student at the University of Washington, it was a big bone of contention that, despite the fact that we did about 70% of the undergrad teaching, we were not considered "staff" and were not eligible for health insurance. We were just "students." Equally our salaries were just squeaking over the top of what at the time was the cut-off for any state assistance. It really sucked. The grad student senate was a very well-organized bunch with thousands of people, but never could get any changes effected. I wonder if this has changed at UW (or at the majority of graduate schools)? I know it was a hot issue even a few years ago.

Anyway, it's all still beside my main point, which was to discuss the propaganda, not the US system. I still find it offensive that such disinformation about foreign systems is being disseminated and, if what tiddles says is right, utterly unchallenged by any journalists. I was surprised to hear that. I would have thought, as someone said above, that it would be a great scoop to show how a lot of the stories circulating really are complete lies.

[challenge]

Anyway, it's all still beside my main point, which was to discuss the propaganda, not the US system. I still find it offensive that such disinformation about foreign systems is being disseminated and, if what tiddles says is right, utterly unchallenged by any journalists. I was surprised to hear that. I would have thought, as someone said above, that it would be a great scoop to show how a lot of the stories circulating really are complete lies.

I don't understand it either. NPR is trying to make a comment when they can report from town hall meetings saying things like "the great misconeption of this took up half the meeting with scared commentors". ... this however is nothing that really reaches out, I think at least. I might be wrong.

I have hopes that the larger networks would have a big "THIS IS THE FACTS" but I haven't seen it so far... and I am sort of doubtful they want to enter that since there are more lies by the day.

Hope is that before the next big debate in the House, it will be a bigger run thrugh of the facts "this is true" but my thoughts are that it will be focused on the facts of the US rather than making the situation in UK/Canada (most used examples as I have seen, with some of Scandinavia and France) and other countries clearer.

[amy c.]

Anyway, it's all still beside my main point, which was to discuss the propaganda, not the US system.

Yes, good point, Jenny. I'll tell you, though,I don't know how much impact it'd have. It's not as though there's terrific,widespread understanding here of how our insurance works, or indeed what it is. You have to remember that the official figure here is 11% adult illiteracy. I would not be surprised to hear that the rate of functional illiteracy is really closer to 20% here.

No matter how the NHS story is reported, it -- like Canadian health stories -- will be reported like so:

A: I never have to worry about my healthcare.
B: But my brother in law in [socialised medicine country] had to wait 18 months for a [body part] exam and wound up dying of [type of] cancer.

Fundamentally, the story comes down to rationing via the state v. rationing via private ability to pay money & pay attention to the rules.

I don't think the private-insurance option is going to change that story significantly, given the giant tangled mess we have here with Medicare and Medigap. Too many people do not understand their Medicare/Medigap insurance -- during the last big overhaul, the govt had to bring in people to try to explain it to the oldies, and it still didn't work so hot. Anytime you deal with private insurance, you're going to have confused people dying of confusion or going bankrupt from it.

I'd say that 80-90% of the insurance-horror stories I've heard boil down to failure to navigate the system -- the person didn't understand his own policy (possibly because he never read it) and make sure he was adequately covered (which entails ability to assess risk), she lost her job and didn't buy a new policy within the period required by law to keep her preexisting conditions covered, he was supposed to call and get permission for the procedure and never did, she got excited about a private enterprise and gave no thought to how she'd pay for health insurance while making no money after leaving her salaried job, etc. It's not much different from the mortgage-nightmare story that way.

Jenny, I suspect that the kind of story you want to see would show how rare the "my brother in law died of cancer" stories are, but at that point you scare away most of the public, incl. most of the college-educated public, incl. many reporters, because you've introduced percentages and risk.

[challenge]

Here is one article about the "misinformation" I was talking about with the elderly euthanasia case....
http://www.salon.com/opinion/conason/20 ... index.html