I went this week to see a specialist – it only took a couple of weeks. Remarkable? Yes, but the GP assumed from my blood tests that it could be cancer. The fact is, the specialist thinks it is extremely unlikely, so I am very lucky. However, it did get me thinking, as I discussed waiting times for operations with the specialist, that these have become much too long, often breaching target waiting times. Unless your need is extremely urgent, in other words, suspected to be cancer, you will wait at least 12 weeks to see a specialist. For dermatology the wait is usually between 6 weeks and 16 weeks, unless it is deemed urgent. Fortunately, many dermatology departments do a teledermatology service, viewing pictures within 24 hours, and providing telephone advice to the GP after that.

But waiting times for an operation are too long, unless it becomes urgent. If a bad winter falls in your waiting time, routine operations may be put on hold. Do you think the extra money promised for the NHS will make a difference? I don’t. The reason it won’t make a difference is because we spend less per person on healthcare than most of the European countries, Canada, the USA, or Australia. All these countries spend more than $4,500 per person per year. We spend $4,246 per person. France spends $4,902, and the Netherlands, to whom we are often compared, $5,386. Germany $5,728. When you strip out money spent privately, we spend less than 8% of GDP. This figure, both in dollars per patient per year, and in percent of GDP, is lower than average for a developed country. The amount spent on private health care in the UK is quite low compared to every other country too. The USA spends about the same on private care as government funded medicaire, so it is an extreme example, and the main reason USA has such high costs. Most countries have at least 10% of healthcare funded privately because insurance policies are more widespread.

I find the cost per person makes the most sense. After all, no matter how wealthy a person may be, one can more readily compare actual costs paid for groceries or travel for example. Most people who commute will know the exact cost of their rail season ticket, rather than the percentage of their household income. If you complete a tax return, you probably know the exact costs of things which are tax-deductible. Healthcare costs of $4,246 per person equates to £3,258 in local currency. As a comparison, commuting by rail from Cambridge to King’s Cross costs £5,125 per year now. Even in Germany, with much lower commuting costs, an annual rail ticket cost £3,840. German public transport is heavily subsidised, and fewer people commute the longer distances we are used to here.

So we spend less on healthcare per person than the average commuter on rail journeys. Now I know what you are thinking, you can’t compare these costs. You use one every working day of your life, the other only when you need medical care. But there are many similarities, both require something like 10% of your income, both are congested systems, with apparently too few seats (beds in hospital), too few trains (hospitals), timetables that don’t work very well, and dissatisfaction. The few who travel first class and pay more will get a seat, a meal or a hot drink, space to read or work, and a quieter environment.

Many people don’t buy season rail tickets, but still spend money driving a car. The cost of insurance, road tax, fuel, and servicing may be less, but taken with the depreciation of the car, this cost may be similar too. My point is that we recognise that running a car, or commuting, costs us personal money, and we need to spend it if this is how we get to and from work, the shops, and the gym. However, when it comes to health, in the UK, since the start of the NHS, we mostly have not yet had to consider the exact cost of healthcare.

Now that I have said this, I realise that over the past twenty years we have been paying for opticians, spectacles, dentistry, braces on our children’s teeth, and cosmetic surgery with our disposable income. Government funded healthcare in the round has gradually been shrinking in real terms, as demand has risen and costs have increased. But we still figure that our taxes pay for our NHS so we shouldn’t have to worry about the cost of healthcare. Except that unless you have private insurance, your experience of healthcare is going to gradually get worse than your experience commuting on the railways. Even when we pay more into the system, it simply won’t be able to cope with our needs, or our demands.

What is the answer then, I hear you say? As with many of society’s problems the answers are neither clear, not easy to explain or understand, or easy to implement. Much of European health care differs in its’ delivery because of the way it has developed over the 100 years since Otto Van Bismark first introduced the idea of social welfare, healthcare, and pensions in Europe. It was well before our NHS, and so the development has been over a longer period. It relies on taxation, employer contributions, employee contributions, insurance schemes, and a top-up by the user. Very different to our system.

I think, as with many of our problems, it would help if politicians and the NHS leaders would get to be more honest about failures in the system-design, and suggest different ways that might be employed to make it better. Honesty is in short supply, as with funding. So we are left with the inevitable process, which is wait and put up with a poor service, or pay more to have care delivered privately if you can afford it. Rail travel is not a bad comparison after all.