Keep our NHS public

[looney]

Time to fully privatise.

 

[RexCathedra]

You need to pay more, get less, and have millions without access at all -- just focus on the massive increases in Freedom™ you'll receive in compensation. Works a treat here in the States.

You've already taken a university system that worked fairly well, and ballsed it up in an attempt to follow our lead -- why stop there?

(Freedom™ and Free™ are registered trademarks of the Republican National Committee. Used with permission. All rights reserved.)

 

[Gazwag]

We need to go back in time to sort the NHS - nurses nowadays go to uni rather than learn it at the hospital, matrons are needed to run wards, hospital managers are paid a fortune to not manage.

The Conquest is full of bullying and homophobia but because most of this is at manager and HR level it gets ignored and swept under the carpet.

 

[clapham_gull]

This is all about this and nothing else. David Cameron trying to "learn the lessons" of Blair and not treat his first term in politics as his last.

They are failing (as part of a coalition) and that's why Steve Hilton has pissed off.

Big Society went first, wouldn't be surprised to see all this watered down and swept under the carpet as well.

 

[dingodan]

I do not like this idea. Can you remind me, would you genuinely completely do away with government health care? The US system (which does have some limited government provision but is far closer to a 'free market') is a bloated inefficient mess, and IMHO we should be moving as far away from that system as possible, not towards it.

The US system is not even close to a free market. It is government managed healthcare.

 

[sten_super]

The US system is not even close to a free market. It is government managed healthcare.

To be honest, I wrote that in the knowledge that you would eventually read it and comment on it. It is closer to a free market than we have in this country, that was my point, and I stand by it.

 

[blue2]

Time to fully privatise.

hence your avatar looney

 

[looney]

hence your avatar looney

What avatar you tool.

 

[dingodan]

To be honest, I wrote that in the knowledge that you would eventually read it and comment on it. It is closer to a free market than we have in this country, that was my point, and I stand by it.

A market is either free, or it is not. You can't show me an apple and claim it proves anything about oranges.

If costs are high, you should ask the question, is government directing capitol into the sector? Answer in both the UK and US is yes.

If quality is low, you should ask the question, does the government have a monopoly on the provision of the service? Again in both the UK and US is yes.

If the distribution is poor, you should ask the question, does the government manage and regulate the sector? Again in both the UK and US is yes.

I understand the attractiveness of everyone being given healthcare for free. But if you want everybody to be able to have access to anything, it has to be delivered by the market. This love fest for the NHS which is so engrained in the national psyche is the real barrier to a fair, equatable, affordable and good quality health care system in this country.

 

[sten_super]

A market is either free, or it is not.

This is quite a good summary of how you see the world. It is not even slightly true - there are degrees of everything, and to suggest that you cannot tell anything about a market by comparing a market with some similar characteristics is incredibly blinkered. To use your analogy, I would imagine a biologist could tell you a hell of a lot about other plants of the same genus and quite possibly a lot more about other kinds of fruits and fruit trees by looking at an apple.

If costs are high, you should ask the question, is government directing capitol into the sector? Answer in both the UK and US is yes.

If quality is low, you should ask the question, does the government have a monopoly on the provision of the service? Again in both the UK and US is yes.

If the distribution is poor, you should ask the question, does the government manage and regulate the sector? Again in both the UK and US is yes.

These are all examples of correlations, but not causation. I could equally say (as an example);
If the distribution is poor, you should ask the question, are private health care firms involved in the industry? Again in both the UK and the US the answer is yes.

 

[beorhthelm]

I understand the attractiveness of everyone being given healthcare for free. But if you want everybody to be able to have access to anything, it has to be delivered by the market. This love fest for the NHS which is so engrained in the national psyche is the real barrier to a fair, equatable, affordable and good quality health care system in this country.

can you provide an example of some where providing this fair, equitable, affordable, good quality healthcare system through only private companies operating in a free market? once we have the model implementation we might be able to review the barriers that exist between our current health services and the panecea you describe.

 

[dingodan]

This is quite a good summary of how you see the world. It is not even slightly true - there are degrees of everything, and to suggest that you cannot tell anything about a market by comparing a market with some similar characteristics is incredibly blinkered. To use your analogy, I would imagine a biologist could tell you a hell of a lot about other plants of the same genus and quite possibly a lot more about other kinds of fruits and fruit trees by looking at an apple.



These are all examples of correlations, but not causation. I could equally say (as an example);
If the distribution is poor, you should ask the question, are private health care firms involved in the industry? Again in both the UK and the US the answer is yes.

Its more than slightly true that you cannot say a free market in medicine does not work, if you do not have an example of a free market in medicine.

And yes they are correlations, and they are a result of a causal relationship. You are not stupid. Intuitively you must realize that inflation (in this case medical inflation) causes high costs? You must see that without competition there is less incentive to innovate, holding down quality? And that centralized control leads to rationing and poor distribution. These things follow on logically.

That being said, I think you are totally ignoring economics. It is all well and good to have good intentions, I like to think everyone has good intentions. But you have to understand how things actually work.

"The curious task of economics is to demonstrate to men how little they really know about what they imagine they can design." - FA Hayek

 

[dingodan]

can you provide an example of some where providing this fair, equitable, affordable, good quality healthcare system through only private companies operating in a free market? once we have the model implementation we might be able to review the barriers that exist between our current health services and the panecea you describe.

Sweden Edges Toward Free-Market Medicine | Publications | National Center for Policy Analysis | NCPA

While opponents of the privatization reforms had predicted that the private sector, by seeking to make a profit for shareholders, would drive costs up and efficiency standards down, the opposite has in fact been true.

 

[ChilternGull]

As a now retired former NHS Chief Executive the NHS is one the few things I do know something about - other than the Albion. I did a long response on another recent NSC thread re the NHS changes so do not propose repeating all that I said then. Sufficient to say that we should all be worried about the potential changes to the NHS that could be introduced assuming the Bill is eventually passed. This is just some of them:

* Ever since 1946 the Secretary of State has been responsible to Parliament for providing a comprehensive health service free at the point of need to the whole population - the Bill removes this
* the Bill provides a framework for the privatisation of all NHS commissioning and provision without any sense of local accountability
* the influence of patient groups as watchdogs is being reduced
* it will be possible to charge for any service (in whole or part) if that is what commissioners decide
* it will be possible for commissioners to reduce or remove services if they so decide
* the currently publicly accountable bodies (Strategic Health Authorities and Primary Care Trusts) are being abolished

And finally these far reaching changes where not in either the Tory or Lib Dem manifestos at the last election or part of the Coalition Agreement.

By all the measures I have ever seen the NHS is one of the most effective and efficient health care systems in the world. Yes it needs to continually modernise and adapt to changing demand but there is no research base to support the notion that the Government's changes will achieve this.

I fo not think most realise what is being done in their name.

 

[RexCathedra]

* Ever since 1946 the Secretary of State has been responsible to Parliament for providing a comprehensive health service free at the point of need to the whole population - the Bill removes this.

That's pretty much the ball game over right there, isn't it?

 

[sten_super]

You are tying yourself in knots here.

Its more than slightly true that you cannot say a free market in medicine does not work, if you do not have an example of a free market in medicine.

What this is effectively saying is that without an absolute example (of a free market in health) neither can I say it does not work, or you that it'll work.

Yet you then go on to assume that it will work. Based upon what? You say that I am completely ignoring economics, yet you are painting the discipline of economics as a single entity that believes that the free market is the best way to allocate resources and that believes that free markets are the be all and end all. This is completely false - as the saying goes, put ten economists together in a room and they will have ten different opinions. There are many eminent economists who are far, far more left wing than me.

The irony of you accusing me of acting in ignorance of the facts and needing 'to understand how things actually work' is not lost on me.

In its simplest form, there's a fundamental trade-off to be had between a free market and an interventionist system. I'd actually agree that a free market (in most cases) gives the 'most efficient' allocation of resources. So perhaps a completely free market health care system would give the largest returns. The question is what those returns are, and who they are for. Private companies are, by definition in a free market system, looking to make a profit. They will therefore (in exchange for participation in the free market) demand a share of the returns from the allocation of resources. The first fundamental question is to what degree that share of returns taken out of the system by the private company counteracts the benefits of a more efficient allocation of resources. And that's without even considering the question of 'fairness' (which I suspect that you'd say shouldn't be considered).

 

[beorhthelm]

Sweden Edges Toward Free-Market Medicine | Publications | National Center for Policy Analysis | NCPA

i didnt ask for an opinion from a think tank advocating the potential benefits, but of an actual example of it in practice. Sweden still runs a government funded healthcare system, and from what i can tell of that link it discusses the inclusion of private healthcare within that system, not a wholesale replacement as you advocate. ( i dare say that it is the Swedish model that the Tories are trying to emulate, they like to nick alot of ideas from there)

 

[dingodan]

You are tying yourself in knots here.



What this is effectively saying is that without an absolute example (of a free market in health) neither can I say it does not work, or you that it'll work.

Yet you then go on to assume that it will work. Based upon what? You say that I am completely ignoring economics, yet you are painting the discipline of economics as a single entity that believes that the free market is the best way to allocate resources and that believes that free markets are the be all and end all. This is completely false - as the saying goes, put ten economists together in a room and they will have ten different opinions. There are many eminent economists who are far, far more left wing than me.

The irony of you accusing me of acting in ignorance of the facts and needing 'to understand how things actually work' is not lost on me.

In its simplest form, there's a fundamental trade-off to be had between a free market and an interventionist system. I'd actually agree that a free market (in most cases) gives the 'most efficient' allocation of resources. So perhaps a completely free market health care system would give the largest returns. The question is what those returns are, and who they are for. Private companies are, by definition in a free market system, looking to make a profit. They will therefore (in exchange for participation in the free market) demand a share of the returns from the allocation of resources. The first fundamental question is to what degree that share of returns taken out of the system by the private company counteracts the benefits of a more efficient allocation of resources. And that's without even considering the question of 'fairness' (which I suspect that you'd say shouldn't be considered).

This shows a total misunderstanding of economics.

The question is what those returns are, and who they are for. Private companies are, by definition in a free market system, looking to make a profit. They will therefore (in exchange for participation in the free market) demand a share of the returns from the allocation of resources.

When you speak of "returns" it sounds like you are talking about the profits for the provider. But there is another side to the "returns". The product or service. The provider will make money, and they should. They earn that money by providing the service, so half of the "returns" of a free market system are in the form of the product or service provided to the consumer. This is in fact the main "return" that we should be concerned about. The provider only gets their "return" as a result of being attractive to the consumer, meaning they must be competitive on price and quality.

The way you seem to be looking at this is that somehow if someone makes a profit, that would take money out of the sector. So when government spends money on healthcare, does anyone profit? contracts are handed out, and the government pays for them. They tend to be quite expensive too.

The first fundamental question is to what degree that share of returns taken out of the system by the private company counteracts the benefits of a more efficient allocation of resources.

You also seem to think that the efficient allocation of resources is secondary to "returns" being "taken out of the system". Do you not see that the efficient allocation of resources is what will achieve the lowest cost and the best quality?

And that's without even considering the question of 'fairness' (which I suspect that you'd say shouldn't be considered).

Yes that's right, because I advocate a free market I do not care about people and have shares in a private medical company. The fairest thing for everyone would be to let people make their own economic decisions, and to let the market do what men with good intentions and grand ideas cannot do.

 

[sten_super]

This shows a total misunderstanding of economics.

No it doesn't - it shows a misunderstanding of your economics.

When you speak of "returns" it sounds like you are talking about the profits for the provider. But there is another side to the "returns". The product or service. The provider will make money, and they should. They earn that money by providing the service, so half of the "returns" of a free market system are in the form of the product or service provided to the consumer. This is in fact the main "return" that we should be concerned about. The provider only gets their "return" as a result of being attractive to the consumer, meaning they must be competitive on price and quality.

I deliberately used the word 'returns' rather than money to try and cover both aspects.

The way you seem to be looking at this is that somehow if someone makes a profit, that would take money out of the sector. So when government spends money on healthcare, does anyone profit? contracts are handed out, and the government pays for them. They tend to be quite expensive too.

That's because the system is already part-privatised. If the government ran the whole thing (which I'm not advocating, but which is the diametric opposite to your viewpoint) then there would be no government contracts - it would all be paid for directly from public funds.

You also seem to think that the efficient allocation of resources is secondary to "returns" being "taken out of the system". Do you not see that the efficient allocation of resources is what will achieve the lowest cost and the best quality?

You state this as if it is an obvious truth - it isn't. It is one possible outcome. Look at the (partial) privatisation of the national rail network and tell me that the privatisation there has lead to the lowest cost and highest quality outcome.

I'll try to make a numerical example - it's a bit messy but I'm hoping it might illustrate my point that, while the market may provide the most 'efficient' outcome, it may not be the best for the consumer (in this case, the patient).

Under a nationalised health system, I pay £10,000 in taxation towards the NHS. I need a heart transplant. Luckily (for the sake of my sums), the 'cost' is £10,000 - £2,000 is taken as the cost of administration (i.e. general running costs of the hospital and the NHS, which is required for the operation to take place) and the operation (including the surgeon's time, the equipment required, the hospital bed, etc.) costs £8,000.

Under a private health system, I (having paid nothing into any pot or insurance scheme) need the same operation. Thanks to efficiency gains from privatisation, the administrative cost to the firm doing the operation is only £1,000 (assuming that there are still general running costs associated with a private hospital). The cost of the operation (including everything mentioned above) is £7,000. So the total cost to the health provider is £8,000, to which they add a £2,000 profit margin. I pay £10,000 for the operation.

In this example the cost to the consumer is the same. But it's easy enough to adjust any of the numbers involved to make whatever point you want - increase the efficiency gains in the operation and suddenly it's better to have a private health system. Alternatively, increase the profit taken by the provider and the national health service is better for the consumer. In the absence of directly comparable real-life examples, we don't know what the right answer is.

These are the kinds of fascinating(!) things that we economists are forever debating, and every time it looks like one school of thought is becoming dominant (due to empirical evidence provided by the ongoing state of the economy) something happens which forces re-evaluation. That's not to say that every opinion on every subject is completely valid, but unless it can be completely and totally disproved it has some merit; and this is clearly an area where it has (so far) been impossible to categorically deny either pole of the range of views.

 

[dingodan]

No it doesn't - it shows a misunderstanding of your economics.



I deliberately used the word 'returns' rather than money to try and cover both aspects.



That's because the system is already part-privatised. If the government ran the whole thing (which I'm not advocating, but which is the diametric opposite to your viewpoint) then there would be no government contracts - it would all be paid for directly from public funds.



You state this as if it is an obvious truth - it isn't. It is one possible outcome. Look at the (partial) privatisation of the national rail network and tell me that the privatisation there has lead to the lowest cost and highest quality outcome.

I'll try to make a numerical example - it's a bit messy but I'm hoping it might illustrate my point that, while the market may provide the most 'efficient' outcome, it may not be the best for the consumer (in this case, the patient).

Under a nationalised health system, I pay £10,000 in taxation towards the NHS. I need a heart transplant. Luckily (for the sake of my sums), the 'cost' is £10,000 - £2,000 is taken as the cost of administration (i.e. general running costs of the hospital and the NHS, which is required for the operation to take place) and the operation (including the surgeon's time, the equipment required, the hospital bed, etc.) costs £8,000.

Under a private health system, I (having paid nothing into any pot or insurance scheme) need the same operation. Thanks to efficiency gains from privatisation, the administrative cost to the firm doing the operation is only £1,000 (assuming that there are still general running costs associated with a private hospital). The cost of the operation (including everything mentioned above) is £7,000. So the total cost to the health provider is £8,000, to which they add a £2,000 profit margin. I pay £10,000 for the operation.

In this example the cost to the consumer is the same. But it's easy enough to adjust any of the numbers involved to make whatever point you want - increase the efficiency gains in the operation and suddenly it's better to have a private health system. Alternatively, increase the profit taken by the provider and the national health service is better for the consumer. In the absence of directly comparable real-life examples, we don't know what the right answer is.

These are the kinds of fascinating(!) things that we economists are forever debating, and every time it looks like one school of thought is becoming dominant (due to empirical evidence provided by the ongoing state of the economy) something happens which forces re-evaluation. That's not to say that every opinion on every subject is completely valid, but unless it can be completely and totally disproved it has some merit; and this is clearly an area where it has (so far) been impossible to categorically deny either pole of the range of views.

You ground me down, can't be arsed anymore.

You win.

Freedom is Slavery.