NHS breaking point?

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Millennie Al
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Re: NHS breaking point?

Post by Millennie Al » Sat Apr 09, 2022 3:48 am

lpm wrote:
Thu Apr 07, 2022 4:08 pm
EACLucifer wrote:
Thu Apr 07, 2022 3:54 pm
the best way to achieve that would be to increase taxes on those who can pay, perhaps by reversing the trend towards taxing unearned income lower than earned income.
I'm sure we all agree that would be the best way.
Considering that there is a group of 650 people who could implement whatever they want merely by agreeing to do so, yet they have not, I think we can be pretty certain that we are far from all agreeing on it (or pretty much anything).

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Re: NHS breaking point?

Post by Brightonian » Sat Apr 09, 2022 6:43 am

Millennie Al wrote:
Sat Apr 09, 2022 3:22 am
IvanV wrote:
Thu Apr 07, 2022 8:42 am
Interestingly, I always thought that Ireland was a country where you have to pay for health care. The Irish have often told me that the NHS is a reason that many Northern Irish might vote against unification whatever community they come from. Yet the proportion of health care spending from public funds in Ireland isn't very much lower than in the UK - 73% vs 78%.
You were right. See https://en.wikipedia.org/wiki/Healthcar ... of_Ireland which says that free healthcare is provided to 31.9% of the population, with the rest expected to pay at least some of the cost of treatments. Non-mandatory insurance is available to cover these costs, and the average annual cost of basic (whatever that is) health insurance was €1,850 in 2017. From https://en.wikipedia.org/wiki/Health_in ... ted_States I find that workers' average insurance in 2009 was $4,824. And, that probably doesn't cover everything. The USA is a completely useless model for health insurance. The Irish system sounds very like what applies to dentistry in the UK - poorer people get free treatment, while richer people have to pay for themselves, but have the option to get private insurance instead of paying everything as needed.
One thing that has been putting me off from going to live with my father in Ireland permanently is NHS care in the UK. I will have to move in with him at some point (he doesn't want to move to the UK) as he's in his mid-80s and weakening. But based on the above it might be sooner rather than later. I did look at costs a while ago and in calculating H + T - L, where:

H = extra healthcare costs in Ireland (choosing from this highly confusing set of maybe 250 to 300 plans)
T = extra tax in Ireland (personal tax appears to be higher in my circumstances)
L = extra living costs in UK (mainly rent),

then it seems it'd only cost me a grand or so more to live in Ireland. And if I can get more timely healthcare in Ireland, then it's probably worth it overall.

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Re: NHS breaking point?

Post by dyqik » Sat Apr 09, 2022 1:15 pm

Remember to factor in the cost in time of working out which plan to buy, making sure that it stays the same over time, managing the claims against the plan, etc.

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Re: NHS breaking point?

Post by lpm » Sat Apr 09, 2022 1:36 pm

Employers offering it as part of remuneration do all that. Chose Bupa A, B or C.
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Re: NHS breaking point?

Post by WFJ » Sat Apr 09, 2022 1:37 pm

dyqik wrote:
Sat Apr 09, 2022 1:15 pm
Remember to factor in the cost in time of working out which plan to buy, making sure that it stays the same over time, managing the claims against the plan, etc.
I think your views are overly coloured by the American health system.

In the German legal public insurance system you will never see a bill or have to make a claim. Deciding which insurance to take is also easy as only 5% of the coverage varies between companies and none of this is anything important that affects the real quality of your treatment. It's only the additional perks that each offer that vary, for example some will offer travel cover, some will pay for extra teeth cleaning/whitening, some subsidise the costs of more expensive dental materials for crowns etc, some will pay towards alternative medicine costs, some will subsidise private room costs if you have to stay in hospital.

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Re: NHS breaking point?

Post by dyqik » Sat Apr 09, 2022 7:52 pm

WFJ wrote:
Sat Apr 09, 2022 1:37 pm
dyqik wrote:
Sat Apr 09, 2022 1:15 pm
Remember to factor in the cost in time of working out which plan to buy, making sure that it stays the same over time, managing the claims against the plan, etc.
I think your views are overly coloured by the American health system.

In the German legal public insurance system you will never see a bill or have to make a claim. Deciding which insurance to take is also easy as only 5% of the coverage varies between companies and none of this is anything important that affects the real quality of your treatment. It's only the additional perks that each offer that vary, for example some will offer travel cover, some will pay for extra teeth cleaning/whitening, some subsidise the costs of more expensive dental materials for crowns etc, some will pay towards alternative medicine costs, some will subsidise private room costs if you have to stay in hospital.
If there's a choice to be made, than that choice has costs.

But if the choice doesn't matter, what you're saying in other words is that the cost of having multiple insurers in the system doesn't produce any significant competition or benefit to the users.

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Re: NHS breaking point?

Post by jimbob » Sat Apr 09, 2022 10:22 pm

dyqik wrote:
Sat Apr 09, 2022 7:52 pm
WFJ wrote:
Sat Apr 09, 2022 1:37 pm
dyqik wrote:
Sat Apr 09, 2022 1:15 pm
Remember to factor in the cost in time of working out which plan to buy, making sure that it stays the same over time, managing the claims against the plan, etc.
I think your views are overly coloured by the American health system.

In the German legal public insurance system you will never see a bill or have to make a claim. Deciding which insurance to take is also easy as only 5% of the coverage varies between companies and none of this is anything important that affects the real quality of your treatment. It's only the additional perks that each offer that vary, for example some will offer travel cover, some will pay for extra teeth cleaning/whitening, some subsidise the costs of more expensive dental materials for crowns etc, some will pay towards alternative medicine costs, some will subsidise private room costs if you have to stay in hospital.
If there's a choice to be made, than that choice has costs.

But if the choice doesn't matter, what you're saying in other words is that the cost of having multiple insurers in the system doesn't produce any significant competition or benefit to the users.
Some comparisons between the US and Canada at the turn of the millennium and between private and state provisions
https://www.cmaj.ca/content/179/9/916.full#sec-2
It is instructive to follow the health care dollar as it makes its way from employers to the doctors and nurses and hospitals that provide medical services. First, private insurers regularly skim off the top a substantial fraction of the premiums (about 15%–25%) for their administrative costs, marketing and profits.9 The remainder is passed along a veritable gauntlet of satellite businesses that have sprung up around the health care industry. These include brokers to cut deals, disease-management and utilization review companies, drug-management companies, legal services, marketing consultants, billing agencies and information management firms. They, too, siphon off some of the premiums, including enough for their administrative costs, marketing and profits. It was conservatively estimated that, in 1999, 31.0% of all health care spending in the US was for overhead, nearly twice the estimated 16.7% in Canada. The overhead for Canada's private insurers that year was 13.2%, compared with only 1.3% for its public system.10

The most popular part of the US health care system is the government-administered system for Americans over the age of 65 — Medicare. This is a single-payer program embedded within the private, market-based system. It is by far the most efficient part of the US system, with overhead costs to government of about 2%.11 It covers virtually everyone over the age of 65, not just some of them. It also covers everyone for the full package of benefits, so it cannot be tailored to avoid high-risk or chronically ill patients. But US Medicare is not perfect, and it has been weakened by the Bush administration. Out-of-pocket costs for Medicare beneficiaries are substantial and growing. Moreover, because Medicare pays for care in a market-based private system, it experiences many of the same inflationary forces that affect the private insurance system, including profit-maximizing hospitals and physicians' groups. In addition, doctors' fees are skewed to reward highly paid specialists for doing as many expensive procedures as possible. As a result, inflation in the Medicare system is almost as high as inflation in the private sector and is similarly unsustainable.8
Have you considered stupidity as an explanation

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Re: NHS breaking point?

Post by Millennie Al » Sun Apr 10, 2022 1:11 am

dyqik wrote:
Sat Apr 09, 2022 1:15 pm
Remember to factor in the cost in time of working out which plan to buy, making sure that it stays the same over time, managing the claims against the plan, etc.
Assuming you're talking about Ireland, I find this: https://help.irishlifehealth.ie/hc/en-u ... ital-Visit from one of the insurers, which says:
2. During your stay

Just let the hospital know that you have health insurance and complete a claims form. Your plan may have a hospital excess which you can pay directly to the hospital.

3. After your stay

You don’t have to do anything – we pay the hospital directly!
so the cost of managing claims is trivial. Don't make the mistake of assuming that American health insurance is a representative model for health insurance in general - it seems to be very much an outlier.

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Re: NHS breaking point?

Post by WFJ » Sun Apr 10, 2022 6:57 am

dyqik wrote:
Sat Apr 09, 2022 7:52 pm
WFJ wrote:
Sat Apr 09, 2022 1:37 pm
dyqik wrote:
Sat Apr 09, 2022 1:15 pm
Remember to factor in the cost in time of working out which plan to buy, making sure that it stays the same over time, managing the claims against the plan, etc.
I think your views are overly coloured by the American health system.

In the German legal public insurance system you will never see a bill or have to make a claim. Deciding which insurance to take is also easy as only 5% of the coverage varies between companies and none of this is anything important that affects the real quality of your treatment. It's only the additional perks that each offer that vary, for example some will offer travel cover, some will pay for extra teeth cleaning/whitening, some subsidise the costs of more expensive dental materials for crowns etc, some will pay towards alternative medicine costs, some will subsidise private room costs if you have to stay in hospital.
If there's a choice to be made, than that choice has costs.

But if the choice doesn't matter, what you're saying in other words is that the cost of having multiple insurers in the system doesn't produce any significant competition or benefit to the users.
They compete on costs to an extent, and the perks as I mentioned. The basic cost is 14.6% of salary split evenly between employer and employee, but this does not cover the total costs so each insurer charges an additional fee that varies somewhere between 0 and 2%. This is paid by the employee alone. So, depending on insurer, the cost to employees is generally 7.5 - 8.5% up to a maximum payment of around 800 €pm. There are no co-pays for treatment and it includes prescriptions and full dental costs (although not necessarily with the most expensive aesthetically-pleasing materials).

The main benefit is that it largely depoliticises health funding and would make any cut to services more transparent. This can prevent the "We are increasing health spending" lies the UK Tories are so fond of, which leave out the "if you ignore inflation and a growing, ageing population" fine print, along with many others. The main control the Government has is to set the basic required level of treatment, the basic cost (which sets employee/employer split) and the cap (which sets how progressive the funding is). Any regressive changes to these things are more difficult to hide.

I do not think the German system is a perfect model. The payment cap and the alternative private insurance system that runs in parallel can be seen as regressive. However most well-paid employees stay in the public system for the additional benefits I mentioned in a previous post (no increases in cost as you age, cover when not working/retired, cover for non-working partners and children until they leave school/university).

I am fortunate that I have never needed serious treatment under either the UK or German systems, but I have had referrals for specialists/scans for minor issues, or to rule out major issues, in both. The difference in the speed and efficiency between the two systems is stark and this level of treatment is equally available to all, regardless of income. I realise this is as much down to total funding as funding model, but the model does help protect this level of funding.

Having previously been against insurance-based health funding on principle, I now think it is something a future Labour government in the UK should look to implement to protect the health system from Tory cuts. However, politically it would be very hard for them to do so, probably impossible within a generation (even assuming they get back in within that timeframe), as the most viscerally opposed to such a system are their core voters.

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Re: NHS breaking point?

Post by IvanV » Sun Apr 10, 2022 10:45 am

Millennie Al wrote:
Sat Apr 09, 2022 3:36 am
Private enterprise does not work by magic - you specify what you want and what you are willing to pay and then either get that or nothing. If you get something else, that's breach of contract and subject to compensation. The main problem is that governments and public bodies are inefficient and incompetent, so frequently ask for the wrong things. This cannot be fixed by giving them even more control over the process.
I think the government sometimes deliberately contracts things out "badly", to save money and screw the poor, vulnerable and unfortunate while creating plausible deniability. Oh contractor, please run a system for us with only a fraction of the money it would sensibly cost, which you know requires you to devise some kafkaesque nightmare for the poor buggers caught up in it. We'll let you get away with it by hiding our evil intention in specifications that are quite inconsistent with what we say you are providing. And we'll create a smokescreen for you with fake-news tropes such as the widespread existence of scroungers, criminals, the work-shy, fraudsters, foreigners, and other unworthies, to justify why so little money is needed in that direction. We see it in disability assessment, many part of the justice system, etc.

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Re: NHS breaking point?

Post by Woodchopper » Fri Jul 22, 2022 7:58 pm

[…]
In country after country, almost as quickly as people left the labour market, they returned. In the EU, there were 5.8mn missing workers by summer 2020, but by late 2021 inactivity rates were back on the pre-pandemic trend. All but one of the 38 OECD member countries had either completed their labour force rebound or were well on the way there by the first quarter of 2022.

Not in the UK. As 37 countries saw an ascent and descent in inactivity rates, Britain’s line kept climbing. Uniquely among developed countries, the number of working-age Britons who are neither employed nor seeking work has risen in almost every quarter since the end of 2019, and was higher in the first quarter of 2022 than at any time since the pandemic hit.

Chronic illness is the main driver of this stalled labour recovery. Of the roughly half a million Britons aged 15-64 missing from the workforce, two in three cite long-term illness as their reason for not holding or seeking a job. It would be easy to point the finger of blame at Britain’s handling of the virus, but the data suggest otherwise.

First, almost all countries have been hit by the same waves of the virus over the past two years, with very similar outcomes in terms of hospitalisation. If the same levels of viral transmission are not causing chronic worklessness elsewhere, it cannot explain the UK phenomenon.

Second, in Spain, a country whose pandemic trajectory has closely tracked Britain’s, not only have all missing workers returned to the labour force, but levels of economic inactivity due to long-term sickness did not budge at all during the pandemic. The same is true of other European countries.

Third, Britain’s rise in chronic illness predates the onset of the pandemic.

With direct impacts of Covid ruled out, the most plausible remaining explanation is grim: we may be witnessing the collapse of the NHS, as hundreds of thousands of patients, unable to access timely care, see their condition worsen to the point of being unable to work. The 332,000 people who have been waiting more than a year for hospital treatment in Britain is a close numerical match for the 309,000 now missing from the labour force due to long-term sickness.

Difficulties in accessing primary care will almost certainly be contributing too, since this is the gateway to diagnosis and treatment. Forty seven per cent of Britons now find it difficult to get through to someone at their general practitioner’s practice, up from 19 per cent in 2012, and 27 per cent said they avoided making an appointment this year because they found the process too difficult (up from 11 per cent).

Covid is undoubtedly a factor in the NHS’s ongoing crisis, through staff absences, additional pressure on hospitals and limiting the capacity to work through backlogs. But where other countries’ healthcare systems are proving resilient, the UK’s is on its knees.

The virus may be the proximate cause of economic inactivity, but it’s not the ultimate one, and the latter must be addressed to heal Britain’s workforce.
https://www.ft.com/content/c333a6d8-0a5 ... pe=blocked

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Re: NHS breaking point?

Post by Sciolus » Fri Jul 22, 2022 8:12 pm

Well yeah. The collapse of the NHS long predates covid.

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Re: NHS breaking point?

Post by Little waster » Fri Jul 22, 2022 9:14 pm

Sciolus wrote:
Fri Jul 22, 2022 8:12 pm
The collapse of the NHS
Surely history has taught us this is a feature not a bug of 12 years of Tory rule?

You can’t really build your Randian low-tax miniarchist utopia if all the horrible poor people are benefitting from a socialised health care system.

They’ll be wanting the vote next.
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Re: NHS breaking point?

Post by Sciolus » Fri Jul 22, 2022 9:32 pm

You're right, I should have said "the wilful destruction of the NHS".

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Re: NHS breaking point?

Post by raven » Fri Jul 22, 2022 10:11 pm

Martin_B wrote:
Sat Apr 09, 2022 12:05 am
At the risk of a derail (and possibly worth a thread on it's own), but do any of the USian posters here know much about the Hawaiian healthcare system and whether it is seen as a good thing and economically sound, or a dangerous communist plot?

I understand (possibly erroneously) that emergency care in Hawaii is free (paid for in taxes, like the NHS) with aftercare being either free or private (presumably private gets you better standard of care).

This sounds more like the Australian healthcare system, which is like a BUPA'd up NHS system - emergency care is paid for, but you pay for pretty much everything else (including ambulances!) and then claim it back from your private health fund. But paying for a private healthcare cover also reduces your taxes (3% income tax if you have no cover, 1.5% income tax if you have private cover).
I don't remember Hawaii being much different to Maryland, but we only used emergency care once or twice while we lived there and that was way back in 2006ish.

If they've made emergency care free since then, good on them. It is a very left leaning state, partly I think because the culture is much more 'we' than 'I' in Hawaii compared to the mainland. ( I once heard Jerry Springer & Micheal Moore describe the difference between UK & US on some late night British TV programe in those terms. It fits.)

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Re: NHS breaking point?

Post by tom p » Sat Jul 23, 2022 12:27 pm

lpm wrote:
Thu Apr 07, 2022 11:48 am
EACLucifer wrote:
Thu Apr 07, 2022 11:02 am
The inherent difference is that the private organisation - unless it is a non-profit trust - is taking some of the money out to stick in shareholders pockets.
I know this feels like it's true, but it's not actually relevant to the nation as an entire entity.

What matters is resources, namely the lack of resources. Profit going round in a circle doesn't absorb the economy's resources. It doesn't reduce the number of nurses in existence.

For a nation what matters is resources being drained away by inefficiency tax dodges and other forms of corporate and personal greed. Private healthcare is inefficient. It's very hard to achieve efficiencies in healthcare as you say. But NHS healthcare is inefficient. Pointing at things and saying inefficient isn't enough.
FIFY.
If you imagine, for one picosecond, that the private healthcare companies will keep al the money they are paid in the UK, then you are living in cloud cuckoo land.
Profits will be siphoned off to dodgy fake companies that exist only to hide where the money goes, which will be into the pockets of the owners, and also, to a lesser, but not insignificant extent, into the pockets of US politicians who they will keep bribing to keep ensuring their cash cow keeps on pumping out the dollars.
The money will flow out of the UK & we will get crappier services with worse-paid and demoralised staff, leading to poor healthcare outcomes for the entire nation, poorer even than now

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Re: NHS breaking point?

Post by Cardinal Fang » Sat Jul 23, 2022 1:48 pm

tom p wrote:
Sat Jul 23, 2022 12:27 pm
FIFY.
If you imagine, for one picosecond, that the private healthcare companies will keep al the money they are paid in the UK, then you are living in cloud cuckoo land.
Profits will be siphoned off to dodgy fake companies that exist only to hide where the money goes, which will be into the pockets of the owners, and also, to a lesser, but not insignificant extent, into the pockets of US politicians who they will keep bribing to keep ensuring their cash cow keeps on pumping out the dollars.
The money will flow out of the UK & we will get crappier services with worse-paid and demoralised staff, leading to poor healthcare outcomes for the entire nation, poorer even than now

^^^ THIS ^^^
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Re: NHS breaking point?

Post by lpm » Sat Jul 23, 2022 3:09 pm

Remarkable.

I write:
Private healthcare is inefficient. But NHS healthcare is inefficient. Pointing at things and saying inefficient isn't enough.
and along comes a moron to point out an inefficiency of private healthcare. He seems to think his observation is a remarkable bit of cleverness. What a f.cking idiot.
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Re: NHS breaking point?

Post by tom p » Sat Jul 23, 2022 5:48 pm

lpm wrote:
Sat Jul 23, 2022 3:09 pm
Remarkable.

I write:
Private healthcare is inefficient. But NHS healthcare is inefficient. Pointing at things and saying inefficient isn't enough.
and along comes a moron to point out an inefficiency of private healthcare. He seems to think his observation is a remarkable bit of cleverness. What a f.cking idiot.
No, you pretended that siphoning money off to private companies wouldn't somehow result in it being a cost to the national economy, 'cos their profits would circulate about.
I pointed out that this was pathetic wishful thinking worthy of a f.cktard like Liz Truss, only I said it nicer than that 'cos I'm a lovely considerate person.
You, as is your way, then pretended you had said something different & didn't quote what you are responding to 'cos you're a mendacious tw.t.

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Re: NHS breaking point?

Post by Woodchopper » Sat Jul 23, 2022 11:37 pm

So, tom p is making a point about macroeconomic policy and not about quality of healthcare. Whereas lpm is making a point about quality of healthcare and not about macroeconomic policy.

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Re: NHS breaking point?

Post by lpm » Sun Jul 24, 2022 9:19 am

Tom is not talking macroeconomic policy, he's gibbering about his adolescent view of the world. He's imagining James Bond villains "siphoning off money to dodgy fake companies" and paying bribes. He's even sub-Corbyn in his connection to reality.

Many parts of the UK healthcare system have been effectively privatised. Dentistry for example. Profits are taken out of the healthcare system by private partnerships or sole traders, with NHS appointments falling and private rising. A major part of it is that dentists can't face dealing with the NHS system, thanks to terrible contracts and tick box bureaucracy. My local 2-room dentist practice doesn't bribe American politicians as far as I know. Profit taking in dentistry is an inefficiency. Is it more inefficient than running everything through the NHS bureaucracy?

Or eye care, the front line for cataracts and glaucoma as well as eye tests, now expanded into hearing aids. Most are private customers rather than NHS funded and we end up paying a lot for visits to opticians and hearing aids. Who are the "fake companies that exist only to hide where the money goes" in opticians? Spec Savers, a private company built from one opticians in Guernsey, Boots Opticians owned by Walgreens, Vision Express owned by a Netherlands company. Is the money lost to the private profit taking more or less efficient than providing eye and hearing tests via the NHS?

Or the private healthcare giants. Like Bupa, a not-for-profit descendent of insurance companies. Or Nuffield, a charity. Or HCA, an American listed company. How much does this inefficiency cost us compared to the NHS inefficiency?

Then there's the non-clinical contracts, such as Serco running cleaning services. A UK listed company. Money taken out of the NHS budget, some of which goes to paying the CEO of Serco a fortune and paying their shareholders dividends. Inefficient, but more or less inefficient than running those contracts in-house?

The NHS is in breakdown because it is so under-resourced. Doctors, nurses, dentists, psychologists are withdrawing from NHS work and going private because they can't bear the agony of stress and bureaucracy. It no longer delivers the basics like emergency ambulances and knee replacements. It's not just the headlines of people dying thanks to the NHS failure, it's the countless people in unnecessary pain for months due to rationing.

You can be an ideological purist all you want, but it's not working in the real world. The childish view that profit making in healthcare is bad fullstop has to be jolted back to reality.
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Re: NHS breaking point?

Post by dyqik » Sun Jul 24, 2022 12:52 pm

Woodchopper wrote:
Sat Jul 23, 2022 11:37 pm
So, tom p is making a point about macroeconomic policy and not about quality of healthcare. Whereas lpm is making a point about quality of healthcare and not about macroeconomic policy.
LPM is glossing over some basic economics to hide the point being argued by deliberately not using quantitative adjectives.

The fundamental thing here is that fragmented private for profit healthcare needs to be significantly less inefficient than national public healthcare to provide the same value to users.

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Re: NHS breaking point?

Post by WFJ » Sun Jul 24, 2022 1:06 pm

dyqik wrote:
Sun Jul 24, 2022 12:52 pm
Woodchopper wrote:
Sat Jul 23, 2022 11:37 pm
So, tom p is making a point about macroeconomic policy and not about quality of healthcare. Whereas lpm is making a point about quality of healthcare and not about macroeconomic policy.
LPM is glossing over some basic economics to hide the point being argued by deliberately not using quantitative adjectives.

The fundamental thing here is that fragmented private for profit healthcare needs to be significantly less inefficient than national public healthcare to provide the same value to users.
How does the NHS's value compare quantitatively to the health systems of Germany, France, Netherlands, Belgium, Switzerland or many other European countries without comprehensive national public healthcare? It's not clear to me that public ownership is required for efficiency or value, and that overall funding is a more important factor in quality of care.

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Re: NHS breaking point?

Post by lpm » Sun Jul 24, 2022 2:32 pm

We don't have a choice. The UK electorate has rejected the inadequate 1.25% levy. It was too unpopular, cost Sunak the PM job and is about to overturned.

The shortfall in healthcare resources is not going to be met by public funding.

It has to be funded from other sources. If we ignore reality we're not part of the conversation about what the future will be.
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Re: NHS breaking point?

Post by Sciolus » Sun Jul 24, 2022 5:40 pm

Some health and care provision, such as GPs,dentists, opticians and care homes, has been largely private since the founding of the NHS. More precisely, providers were not direct employees of the NHS, but contractors. What has changed recently is, they used to be small practices, partnerships, small businesses, and as such, the money they were paid for their services remained in the local economy. Increasingly, they are owned by huge corporations, often multinational, based in tax havens, owned by private equity funds, highly leveraged, and generally set up to ensure as little money as possible remains locally and as much money as possible gets sucked out of reach of HMRC. We have seen how well that works for users and taxpayers.

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