Hmmm. Healthcare in the US costs twice what it does in the UK as a percentage of GDP, and the individual spends around 150% of the UK total - stats from here but there are multiple sources. We also have a higher life expectancy and more doctors and nurses per capita. I'm not certain that "People with full-time jobs with benefits get many options, choices, plans, doctors, deductibles, etc - at arguably the same premium contribution (taking into account what the employer is playing) as you in the UK are paying through through your cumulative NHS funding." holds. But that's very much a side issue and I'm not sure its productive to dwell on it.
I completely agree with you regarding the cost efficiency of the NHS system on healthcare spending per capita. As I said in my post, the UK has a functionally sound, efficient system in comparison to the current state of private insurance in the United States due to a variety of economic factors (rising unemployment, reduction in full time jobs, etc.). However, per capita healthcare spending is an aggregate individual average for expenditure based on all individuals taken together (whether or not they have insurance). My statement in my last post, regarding the private insurance industry being superior for some Americans, was purely with regard to those Americans who are receiving employer-subsidized healthcare, and their particular net expenditure, on their own healthcare. In other words, to do a proper analysis, we would need to compare an American woman's individual contribution to her health premiums for a year, versus a British woman's empirical $/£ amount of their taxes, that goes to fund NHS. Both individuals would need to be identical as far as their incomes and attributes, but I agree with you, that this type of analysis is largely a moot point when discussing the overall efficiency of the system at large. Your point certainly still stands, that %GDP spending is considerably higher in the US vs. UK, and one that I never refuted.
As far as choice, I was actually referring to monetary freedom, as well as healthcare choice freedom (and obviously these views here reflect the pre-ACA landscape). Private insurance is quite affordable to the average full-time employed individual, while in the UK, private insurance is largely out of reach for the average full-time worker. I'll address Ebb's point regarding the number of private insurance choices below, but in an ideal economic climate, the average American full-time worker will have more flexibility in obtaining a plan that fits his/her desires and needs. For example, in the UK, the National Institute for Health and Clinical Excellence (NICE) determines which drugs and treatments will be covered under NHS. I like knowing that if I choose to purchase the highest-tier private insurance through my employer, which is affordable, albeit a little pricey in comparison to other plans the employer offers, that I can receive superior coverage, far beyond what the NHS would offer. If a similar person of similar income were living in the UK, the likelihood that they could even afford a similar private plan is unlikely. There's both pros and cons to both healthcare models, and we can both form opinions on what we feel is logistically better in our perspective.
The unfortunate reality with such a situation though - and one can hold differing ethical views on this - is that part of the reason I have the ability to opt into a little pricey yet affordable private insurance is because there is a significant population in the US that is not receiving healthcare access. This goes back to my original point, that the real factor here is bleak economic prospects, and lack of good jobs that offer employer-subsidized private insurance. I believe that emphasizing premium cost reduction in American healthcare will naturally allow our healthcare model to function with more efficiency and access - in addition to necessary legislation.
Do you have cites for either of these facts? They run directly contrary to my experience, and what I've read. In general the trend seems to have been employers putting a higher percentage of insurance costs on their employees. After all, even if there is a tax reduction for increased insurance subsidies by the employee, that reduction is far short of 100%. It still costs the company more to provide better benefits. To the extent that this is useful as a recruiting and retention tool it is worth the company's money. But it's hardly free for them.
I'd also dispute that having employer-supplied benefits results in more choice for the employee. On the contrary, the vast majority of companies offer only a very few options. Perhaps you're focusing mostly on very large corporations? I have worked at companies ranging from six employees to about thirty thousand, and it was only at the very largest that there was any substantive choice in plans available (beyond 'family' vs. 'single')
My opinion is that the marriage of full-time employment and availability of health insurance is an historical accident that does far more harm than good. Before the ACA, for instance, it was not uncommon for someone with a chronic medical condition to be essentially bound to their current job for fear that switching companies would result in a failure for the new insurance provider to cover their treatment. This results in a suppression of the free market in terms of peoples' ability to choose their own jobs.
I'd be very interested to hear the other side of the argument, though.
Here are the "Share of premiums paid by employer and employee for family coverage" for 2013 from the Bureau of Labor Statisticshttp://www.bls.gov/news.release/ebs2.t04.htm
Based on that data, employers seem to be covering premium costs in the high 60s to mid 70s percentages. I would agree with you that it is by no means a free endeavor for companies, and the tax breaks the government is offering for greater percentage coverage by employers is by no means fully eliminating the cost involved. However, like you said, its use as a recruitment and retention tool, in addition to its strong tax break incentives have made this a generally accepted, and growing, practice among American employers.
Again, I fully agree with you that there are many negatives to our current model of healthcare. The reality is that our current economic climate just isn't compatible with the way our private insurance industry is set up. Historically, there used to be a time in the US when it was "normal" for the average person to stay with one company their entire life. That isn't the reality anymore. In addition, there used to be a time when insurance companies really did compete with one another (before these mega-insurance conglomerates). When you have truly efficient competition, without today's insurance lobbying, you'll actually have multiple smaller insurance companies competing with one another to get "contracts" for small business employers. Basically, the insurance company which offered the most plan varieties would win the contract. But you're right, those days are slowly dying away, and in some cases, are gone. Several states have only 2 insurance providers now, and as you can imagine, they illegal collude with one another to prevent true competition. So far, we've done our best with Medicaid and Medicare, to prevent people from slipping through the cracks, but it really isn't enough.
The real question then becomes, do we unilaterally find fault with the infrastructure and system itself of American healthcare, or do we find fault with the illegal practices? Personally, I believe it is the latter. I'll be the first one to say that modifications are absolutely necessary, but I think an attempt to massively overhaul the system will ultimately do more harm than good.
In this discussion, I'm really trying to analyze viable solutions that can realistically be achieved. Whether we love it or hate it, the federal government can't just get rid of private insurers from dominating the healthcare industry, so suggesting a complete switch to an NHS-style system just isn't realistic (at least over the next couple of decades). Some were saying the ACA was the first step in that direction, but as I have tried to convey in this thread, from what I can see, it seems to be causing more problems so far than improvements.
What I proposed above, involving "premium-free" emergency coverage to those without insurance, and highly subsidized premiums for at-risk individuals, and those with pre-existing conditions, seems to be the most sensible step in the right direction. With a such system, no one will be "dropped" from their existing insurance plan (the only difference will be, employers may cover a lesser percentage of their premiums). So in other words, the empirical cost of premiums won't change, but the amount most employees have to pay, might be higher.
It's not really a win-win situation, nor really a desirable one (who wants to pay more?). But just seems to be the right way forward.