though I have not seen data to back that up. We do have a paper from the Royal College of GPs this year which cites a 240% overall increase in referrals over five years: (https://www.rcgp.org.uk/-/media/Files/Policy/A-Z-policy/2019/RCGP-position-statement-providing-care-for-gender-transgender-patients-june-2019.ashx?la=en …) The same paper says, as of 2018, the average waiting time for an initial 2/
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GIC appointment was 18 months. Based on my conversation with CHX last month, that's exceeded two years, and incoming referrals continue to grow: "The Tavistock & Portman clinic alone received 283 referrals in March 2019, an8.43% increase from March 2018." 3/
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It may be easy to point to the growth in referrals as the cause here, but there's wider structural issues in the NHS. Waiting times for specialist services are out of control. ADHD clinic wait times reach several years, for example. 4/
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Our government has consistently underfunded the NHS. My pet theory, as a cynic, is this is being done deliberately to reduce its service level to being so poor that parcelling it up for sale to private investors and firms for privatisation can be plausibly sold as salvation. 5/
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And I have no doubt that the MPs who are steering this course will benefit financially. We just had an election where the future of the NHS was a big point of the campaigning, and you lot returned the status quo with an even bigger majority. 6/
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I say you lot because I'm an American with no vote here, despite having lived here many years and holding settled status. I've made my home here, I've all but naturalised. But, I remember how the healthcare system works in America. I don't think many Brits know, so allow me 7/
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to tell you what it's like to live with an insurance based profit driven healthcare system. We are sold what are quite literally insurance policies, with all the normal features like risk based pricing and deductibles (Brits may know the term as an 'excess'). 8/
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Risk based pricing includes such factors as sex (uterus owners get pregnant, and that's expensive), age (old people cost more), any preexisting conditions (these might get you declined outright), or whatever else an actuary in a cube farm can use to justify charging you more. 9/
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The deductible (or excess, for the Brits) is an amount the policy holder must pay before the insurance company starts picking up the bill. What's real fun is that even on a policy with multiple "beneficiaries", e.g. a family, deductibles are per person. Each person has one. 10/
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This leads to fun situations like the cost of childbirth is deductible * 2 - they'll exhaust mother's deductible, and then if all goes well a new beneficiary emerges with a brand new untouched deductible and they'll take that too. 11/
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But what do these things actually cost, you might be wondering? Best case middle class scenario, you have a good full time job with an employer who buys the health insurance and withholds some of your pay to cover a portion of the cost. Typically, two plans will be on offer: 12/
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one with a high deductible and one with an even higher deductible. I've seen recent numbers like $500/mo premium for a deductible around $8000. If you aren't fortunate enough to have a full time job with 'benefits', you're on your own, and your costs are higher without 13/
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the economies of scale an employer buying a block of policies brings to bear. Your insurance premiums may match or exceed your rent. Now, this is simply the cost of buying the insurance. What about when you need to use it? This is where shit gets real wild. 14/
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These insurance companies are also marketing their 'services' to health care providers. This service is basically being one of the providers their customers can access. See, these insurance companies have 'networks' of providers, and they will not pay for services rendered 15/
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by providers who are out of their networks. The onus is on you, the consumer, to select and use only providers with whom your insurance company has negotiated a deal. If your need is as simple as selecting a family GP, this is manageable. But, what if you're incapacitated? 16/
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Imagine a scenario where you are in a car crash and seriously injured. Maybe you need a helicopter ride to the hospital because it's quite serious. You can't consent, you can't choose, but you happen to be dispatched a chopper service that isn't in network. Bad luck. 17/
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My brother did that once, I think the helo ride was about $25k? Anyway, you get to a hospital and luckily the hospital is in-network. You need some surgery. The surgeon is also in-network, but the anesthetist is not. Maybe she bills like $80k. Sucks to be you. 18/
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On and on this goes, and you come around a few days later having exhausted your deductible and your insurance company are covering an awful lot, but oops, you accidentally used some out of network services and now owe the hospital and an ambulance service lots of money. 19/
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Quarter to half million dollar medical bills from such incidents are not unheard of, and medical debt is by far the leading cause of bankruptcy in the US. Now, insurance companies don't actually pay these numbers. Remember those deals they forge with providers? 20/
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Those are largely about discounts. Really damn steep discounts. That anesthetist who billed you $80k may be billing insurance companies she deals with $3k by comparison. This kinda leads to a really skewed perception of how much healthcare actually costs, because we 21/
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the consumers may not be aware of what insurance companies actually pay. It may come as no surprise that I'm waiting around for some surgery. I've looked into the cost of sorting it privately and was quite frankly shocked that it is less than the value of my house. 22/
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It's still a lot, and I recognise many can't even conceive of saving that much. Caveat: I moved to the UK before Obamacare was implemented, things may have changed. But I doubt the broad structural strokes of how the end consumer gets fucked hard (and not in the fun way) 23/
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have changed significantly. I mentioned preexisting conditions above briefly - insurance companies can simply decline to cover a condition you had before you became their customer. Obamacare stopped this, but I think that protection has been rolled back. 24/
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Another thing I remember is lifetime benefit caps. These may be gone, but they were hard lifetime limits after which you were on your own, probably left to simply die. This is gonna continue more, but I can't click the 'add tweet' button anymore. 25/
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Anyway, that's the gist of how shit life is when healthcare is a thing for the enrichment of a few shareholders rather than a human fucking right. I don't think you lot adequately appreciate your NHS. Even in its current underfunded and sad state 26/
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It's an absolute gem, and the envy of many worldwide. And yet you have returned to power the same people responsible for shaving it down to its current barely functional state, with an even bigger majority. I honestly didn't want to veer into politics on this one. 27/
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But it's a government service so I guess it was unavoidable. I'm a sort of outsider. I see what is beginning to look like an inexorable march toward the death of the NHS, and I want to scream at all of you to stop it, you don't know how good you have it. 28/
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It's already broken. The wait times above? Those are in contravention of the NHS's own constitution which states that the maximum time to a specialist appointment following a referral is 18 weeks. It's already being privatised. My local services are provided by Virgin. 29/
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We're already being encouraged to buy private insurance. My employer offers it as a 'benefit'. They shouldn't have to. Your politicians moan about how hard it is to fund it and yet Amazon pays fuck all in taxes. We can pay for the NHS, but they'd rather sell it off. 30/
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And it'll be companies with MPs as owners, board members, or shareholders who are doing the buying. You watch. It may not be as overt here as it is where I come from, but money talks just as powerfully in Westminster as it does in Washington. 31/
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