>I could see a single payer system having the same problems.
You can look at the UK right now. The root problem has nothing to do with health insurance companies or who is paying. The problem is drastic increases in net benefit recipients relative to net payers/labor providers into the system.
I.e. declining proportions of healthy, working people willing to provide labor at a sufficiently low price, such that in order to keep providing the same level of service, more and more of the country’s resources have to go towards healthcare.
The other problem is also advancements in medicine that keep people alive longer and longer while utilizing ever more healthcare services.
To be fair, the current govt is preciding over a (self inflicted) economic collapse in all areas, not just the NHS.
And ultimately voters have no-one to blame but themselves. (or half of them anyway.) leaving the EU is epically dumb on a truly impressive scale.
So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces.
Japan might be a better place to look if you want examples.
In truth the US has plenty of money in the pot to implement effecient health care. But for-profit companies will not go quietly into the night.
> So now looking at the NHS, complaining about under-funding and under-staffing, when those were completely predictable outcomes of Brexit isn't going to inform good health system forces.
I don't agree with this. I don't live in Britain, so I'm not fully aware of how Brexit has affected things over there.
I live in France. Didn't leave the EU, as a matter of fact it's one of the countries pushing the most for it. Same issues with the health system. A few months ago we were rationing paracetamol. Now we're back to not allowing sales of it online because of shortages.
I'm not saying Brexit helped, but I doubt it was the main cause, seeing how the same exact effect happened elsewhere, at the same time, while staying in the EU.
It would seem to me that, for whatever reason, many countries chose efficiency of the healthcare system above all else. Meaning closure of hospital beds, reduction of medical staff, etc.
This may be great for producing cheap Toyotas. No one cares if theirs is one week late because something unforeseen came up. It doesn't work as well for medical emergencies.
Its pretty easy to find shortages and flaws in any system.
And yes, national health is always tempting for budget cuts because its a huge number, and trimming it 5% gives real returns.
Shortages of drugs and equipment are often tied to supply-chain issues more than budget, and again that's a barrel of worms best left for another thread.
Clearly single-payer can work, but it does need the single-payer to, well, pay.
Brexit is a large factor because the UK was a net-importer of aid from Europe. And Europe was the biggest trading partner. Predictably leaving has decreased the economy such that tax revenues are down, which in turn means less to spend on social services.
Then we can talk about freedom of movement, and the number of Europeans who staffed the NHS and who no longer do so, and cannot be replaced by other Europeans.
So sure, the global economy is taking strain at the moment. Brexit is not the only cause. But its a pretty big sucking chest wound.
Sure, every situation has its shortcomings, possibly even big sucking chest wounds which don't help.
But my point was that if multiple systems, some of which seem different (US vs EU), all with different apparent wounds, appear to fail in the same way at the same time, maybe there's something that's common among them which is the actual cause. Perhaps it's just a coincidence. But which is more likely?
France absolutely has staff and funding shortages, on top of the supply chain issues for medicine [0].
For the US, there sure is the affordability issue, but I don't think that's anything new. However, OP's point is that there had already been staff shortages for a while before COVID, but now the proverbial camel's back has been broken:
> Ultra lean staffing prior to covid led to the sh*tshow during the pandemic and, now that everyone is quitting, things are now in total collapse. [...] There are 30 rooms in the ER, but 3 nurses overnight…
This is the exact situation in France. The hospitals are physically still there, but there's not enough staff.
I don't get why the underlying problem is not even being discussed here at all. Any attempt to fix the system will have to increase investment in both training and drug research.
This will be a large investment (if doubling the training budget produced double the graduates that would not be enough), and will NOT bear fruit until those people actually graduate, which is 6 years minimum, and mostly 10 years away. So for 10 years, it means paying through taxes while getting minimum to no improvements in return. Furthermore, such a large increase is not possible at short notice, even if the money is available, so it will take more than 10 years time.
For research one might take profit margins of large pharma as an indicator: a fully nationalized, but equally capable, pharma research system would cost some 15% less, assuming nationalizing introduces zero inefficiencies. BUT that money would have to come from taxpayers directly through the government budget.
And nobody is looking for 15% reduction in drugs costs. That just won't move the needle enough. So in reality the government would have to increase the drug research budget to make drugs cheap.
Failing to do this will mean medicine becomes less accessible to people, regardless of whether we switch to a single payer system or not.
So let's get real here: we will fail to do this, and it will get worse.
The problem in the UK is that conservatives and neo-liberals have been actively dismantling the service over the last 20 years.
At a time when there were already staffing difficulties conservatives dis-incentivised people from becoming nurses by removing training bursaries.
Parts of the system have already been stealthily privatised with the associated drop in quality and additional costs. In many cases employees of the NHS are simultaneously being paid private rates using public money through schemes like "right to choose".
At a time when staff nurses are being told they don't deserve higher pay, private agencies are being paid >3 times the staff rate in order to fill gaps in staffing caused by lack of pay and overwork. The result is artificially inflated staffing costs and an incentive for the remaining staff to move over to the agency for what is often double what they'd be earning.
The correct course of action is to bring costs back into line by expunging the parasitic private healthcare system. Every agency position eliminated pays for 2 staff nurses with a healthy pay rise. The improvement to staffing ratios would further improve the nature of the job.
Let poorer countries pay to train nurses and doctors, and then wealthier countries take the best because they can pay more for them due to economic dominance.
We do it in New Zealand by importing a lot of doctors (Chinese and Indian seem common), and nurses . The reason we need to import doctors is because we export a lot of doctors and nurses to wealthier countries such as the USA.
In New Zealand, we get people from poorer countries because we can pay more, and we also get people from first world countries because people want to move here for the lifestyle or for their children.
You can look at the UK right now. The root problem has nothing to do with health insurance companies or who is paying. The problem is drastic increases in net benefit recipients relative to net payers/labor providers into the system.
I.e. declining proportions of healthy, working people willing to provide labor at a sufficiently low price, such that in order to keep providing the same level of service, more and more of the country’s resources have to go towards healthcare.
The other problem is also advancements in medicine that keep people alive longer and longer while utilizing ever more healthcare services.