The NHS has been turned into what is effectively a state religion in some quarters. It's untouchable. It can't be criticised. It's immune to meaningful improvement and reform at this point. Yet everyone I know who works for the NHS has a litany of stories about the inefficiency and waste. And it consumes an increasing proportion of the GDP. Eventually, something will have to give.
Its been on an unsustainable path since its inception. It's always been in crisis and needed increasing amounts of cash. Cash that we taxpayers have no choice but to pay up. The NHS isn't optional, it's mandatory.
If we have the option to opt out of paying for the NHS and go private, many will do so. I already have to pay twice over. I pay privately through my employer's plan, and then again for the NHS. I suspect if there is the possibility of opting out and going entirely private, many would do so. At this point it's the only way to ever get a GP appointment for many of us.
The problem with the debate here is that it's always framed in terms of UK vs US funding models, both of which are horribly broken in different ways, and never looks at other European countries or other systems around the world, some of which have systems which work better and provide better health outcomes for less money. If we were to privatise it along French lines, for example, it might be a massive improvement all around. But that debate has never happened.
And yet it is the private system in the UK that is taking away scarce supply from the NHS making it more vulnerable.
There is a supply side limit on doctors and nurses, which means private healthcare works like the Fast Track queue at Alton Towers. All it does is allow people with money to jump the queue at the expense of everybody else.
And remember that since the inception of the NHS Primary Care, ie the GPs, have always been private businesses. Yet that is the bit that is completely on its knees at the moment.
This isn't a private vs public argument. It's far more fundamental than that. It how do we share out increasingly scarce resources in a country that is getting poorer.
We make people pay for them. Like we do with every other resource on the planet.
Healthcare is something which should be accessible for all, and we can of course subsidise the less well off. But it still ultimately needs paying for.
It's not a system doing it. Healthcare professionals are choosing to work for private companies instead of the NHS. If you would like to ban that, then say so, but don't pretend there's an amorphous system to blame.
Some of that demand has money, therefore the private system will take capacity away from the NHS to supply the money. Of course it will.
That is jumping the queue.
Therefore as a society we have to ask whether we want to uphold the NHS's founding aim: "Healthcare free at the point of delivery based upon need not ability to pay".
We can't fix the supply shortage by taxing the rich. But we can stop the queue jumping by constraining who private healthcare is permitted to treat and in what order.
For the record I don't like the Fast Track queues at Alton Towers either. That's not the British way. In Britain we stand in line - whether Lord or Leper.
In this instance, the resources are humans, and it seems you want to force humans to do something they don't want to do. If you want slave-doctors just say so. It worked for the Romans I guess.
The exact argument is "doctors/nurses are limited, and they aren't behaving how I think they should behave. Let's fix the system so they have no choice". I guess that isn't slavery, that is just funneling people into a single path which they clearly don't like, because they reject that path when they have literally more than one option open to them.
We also have a hugely archaic system in the Royal Colleges. In no other profession do we expect people to sit regularly very expensive professional exams, and expect the staff to fund them out of their own salary rather than them being funded by their employer. £600 a go is not unheard of.
We do. And you know why. Because the NHS has no more capacity to train any more than that. In fact this last year it has struggled to do that because it was more interested in ensuring its staff had masks on properly than getting the job done. First year medical student placements in hospitals were the first to get the chop.
To train more people in any system, that system has to do less of what it is currently doing and more training. We can't afford that in the NHS, which is already struggling to meet demand.
Ultimately the problem is that we spent the seed cord in the 1990s, and we're struggling to replace it.
You’ve also misrepresented the nature of private healthcare in the UK - this is almost universally not a replacement for NHS services. It will offer you things like faster GP appointments, consultants, and routine operations. It will not replace many of the specialist or emergency services offered by the NHS, leaving you dependent on it anyway.
A bigger “problem with the debate” is that we so frequently find people like yourself who are insistent on having some kind of “debate” without really knowing about what, or why.
I mentioned that we don't have the right to opt out of paying for the NHS. It's not possible go entirely private. If you could opt out, you could pay that money to a private provider instead and entirely forego the use of the NHS. That isn't an option today. But it should be.
Because the public healthcare system winds up subsidizing the private one: private insurers dump bad risks onto it when they get too expensive too insure, after years or collecting the payments that don't go to the public system.
It's the definition of privatizing profits and socializing risk.
You want to opt out? You get to opt all the way out. You don't get to come back, it's a one way street. Still keen?
In this scenario, why should an NHS ambulance pick you up when you don't contribute? Surely it should prioritize those on public healthcare? Some poor lad whose leg is broken from a fall?
We are forced to spend a significant fraction of our salaries on the NHS whether or not we want to. If we feel that this is not good value for money, or of poor quality, we don't have any real option of choosing to pay an alternative provider. Like all nationalised industries, it's inefficiently run because top-down administration of huge organisations blunts initiative and freedom of action. It's run by Whitehall and politicians, with little input from those actually doing the real work. And the result is that it's in perpetual crisis, with COVID having pushed it right over the edge. Is it really fit for purpose? I don't personally think so, and haven't for many years.
Competition is good for many reasons. It improves the quality and value of goods and services. The NHS has no real competition. There's no direct cost of failure, no direct cost to poor purchasing decisions, no direct cost for poor quality of service, and no real driving reason for improvement in the quality and efficiency of its services. They get the money anyway.
Other healthcare systems in Europe have fully private provision--you have the choice of where to take your money, even if you paid into a public system. If a particular hospital or clinic is providing poor or expensive service, you can take your money elsewhere which is better quality and better value for money. That's a very real incentive to drive improvement and efficiency. That is not the case for the NHS system. There is no choice, and the incentives to improve are minimal.
If there is to ever be any improvement in the NHS, there needs to be competition. The NHS should be somewhere you choose to have treatment because it's the best option, not because it's the only option.
On a small scale, there is some degree of separation. Sometimes the NHS pays for treatment in private facilities, and sometimes private insurance pays for treatment in NHS facilities.
Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess.
> It's run by Whitehall and politicians, with little input from those actually doing the real work.
If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.
Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess.
> It's run by Whitehall and politicians, with little input from those actually doing the real work.
If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.
> If there is to ever be any improvement in the NHS, there needs to be competition.
What is "choose and book"? We tried competition, and it dramatically increased costs without doing anything at all to improve care. We're now spending considerable amounts of money rolling back some of that law.
Regarding competition, the NHS hasn't really tried competition seriously now, has it? Not really. Not actually doing a complete decoupling the insurance funding and the service provision. The "choose and book" isn't that, is it? It's a small attempt, which is better than nothing, but it's not really surprising that it didn't drive a huge amount of change, when it's not really going to have a big impact upon the bottom line.
A mess in what way? Do you have to wait 2 years for a private dentistry appointment? Because that's the current wait time for an NHS psychiatrist.
If you can't afford private treatment you go on the NHS. At the moment NHS dentistry is simply not available for very many people. Those people cannot get treatment at all. But for psychiatry, the vast majority of people who need a psychiatrist will get same day or next day access. This is one of the problems - that's a statutory function, they must provide it, and so community care has been cut in order to meet the statutory function.
> Because that's the current wait time for an NHS psychiatrist.
This is untrue in the way that you've presented it. I'm not able to find this statistic any where - what's your source for it please?
There are long waits for some community mental health services, but these are mostly caused by decades of underfunding of MH treatment. Also, your argument says that this problem would be fixed with competition. We've competition and right to choose for first episode of mental health care since 2014[1] and that competition has done nothing to improve things and in many situations has made things worse.
For Early Intervention in Psychosis services (these are services for people with their first episode of psychosis) the current numbers[2] are that 83% of people were seen within 2 weeks after referral.
The number of people in contact with specialist mental health services has increased[3] since 2019 from 1.3m to 1.6m people. This is combined with a decrease in bed numbers and a complex change from CCGs to ICSs. New referrals data is complicated (one person can have multiple new referrals; someone already in contact with services can have a new new referral) but the trend is increasing[3]. The number of young people accessing MH services has increased a lot over the past 12 months, from 575,000 in Mar 2021 to 690,000 in May 2022.
[1] https://www.england.nhs.uk/wp-content/uploads/2018/02/choice...
[2] https://www.england.nhs.uk/south/our-work/mental-health/earl...
[3] MHDS Mental Health Time Series data dashboard
Employed middle aged workers in the USA pay about the same as we do for the NHS to support Medicare, Medicaid and CHIP through taxes, and then have to pay about the same again to actually get health care for themselves. Plus the system that costs twice as much as ours per citizen still leaves tens of millions of Americans without health insurance. It's utterly godawful. Our current system where everyone supports the NHS, and if you want top up services you pay for it, ensures solid funding for everyone's health care. The fact that my private care actually subsidises the NHS by reducing demand on it is a feature, not a bug. There's also the fact that private health care increases overall investment in health care, so in emergencies the NHS can call on private medical facilities which otherwise wouldn't be available. I know there's a fairness argument, but in practical terms our system benefits everyone.
For what it's worth if you have the money you can get some pretty world class care here. My dad had cancer and due to my mom's really good (publicly provided mind you, she worked for the school system) insurance got my dad great care and he's still out an about to this day
edit: and of course you'll rely on NHS for any emergency.
[1] at least not without paying out of pocket for the significantly more expensive premium coverage. Some now offer phone consultations but you still need to go to the GP for referrals and prescriptions.
And fuck the NHS. Smash the shit out of it. We'll all die exactly the same number of times without it, but be healthier and happier on the way.
Someone with the default tax code would take home £ 25,539.52 which means they pay 20.2% in tax. It’s quite low by many countries standards but certainly not 15%.
You do have overlapping cover, but the most expensive cover (GP, long term chronic conditions, emergency care) are provided by the NHS. It’s far from clear that you would pay less if you had to cover the whole through a private policy.
(excuse the gallows humour)
No, they want cost-effective healthcare. Almost everywhere else in the world uses a mixed public-private model for healthcare, which IMHO keeps a lid on the excesses of government spending into the money pit of fully-public healthcare.
https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...
Eg: It's currently almost impossible to get routine or early-stage healthcare. If I want a routine doctor's appointment, I have to phone every day at 8am when the next batch of appointments are released, and hope I get one. Last time, it took hours on hold, and attempts over several days, to get one.
I believe appointments are now run more efficiently due to the backlog and changes in processes due to Covid, with the reason for an appointment usually submitted digitally first, followed by an efficient telephone consultation that is well prepared based on your submitted reason for needing an appointment, and a follow-up consultation as necessary. Perhaps your GP surgery in particular is struggling, or you are perhaps not engaging with the new approach.
I have been surprised at just how well functioning the health service is right now despite the incredible pressures on it, but perhaps my local area is coping better than others.
Importantly, however, this issue was broadly not present 10 years ago when the NHS was better funded to meet its needs, and was still cheaper than other countries. So the issue is not the NHS, but funding, which is also corroborated by our relatively low level of health spending.
Depending on what happens in the next few years it could well be that they become the party against power. Which would be a rather interesting inversion from the last 40 years.
Which raises a lot of uncomfortable questions for people whose world was informed by Reagan, Thatcher and Bush.
While this wasn't previously the case, the spatial and socioeconomic patterns are increasingly similar to that of the Democrat/Republican voters in the US, from what I can tell. The leftward travel of the Democrats is a large part of that. But the left/right inversion in the UK has been slowly coming for decades, but the FPTP system hid that in the outcomes.
There's also the European angle. Those who want to work likely faced competition from EU workers and generally feel hard done by when it comes to globalisation. After all, if you worked in coal, steel, car manufacturing or your family did, quite likely you, or a relative, has lost a good portion of that work to cheaper manufacturing abroad. Which is more appealing: Labour, who prevaricated on Brexit, or BoJo, who simply said he'd do it? It isn't all that different to 'America First' in its appeal.
There probably wasn't any way to avoid the demise of coal, especially given our need to combat climate change, but did Labour provide an alternative? During the 2000s, Labour massively expanded higher education but also increased 'student debt', and only paid lip service to apprenticeships. If you're working class and working/aspirational, likely your budgeting is quite strict. Things like 'debt' and 'loans' generally mean 'trouble' and not a solution.
I agree this is broad strokes, but Labour has a problem in that it no longer actually represents its traditional demographic.
The typical profile of a brexiteer is somebody retired, not somebody in employment, and I think the reasons are largely ideological, rather than practical; polling showed people who supported brexit would still do so if the hypothetical included economic pain.
That said, I stand by what I said. If you look at maps of brexit voting tendency, you'll see they map quite heavily onto rural communities and former industrial heartlands. My explanation for this is that they don't see or feel the benefits of the EU and globalisation. But we didn't have a referendum on who wants globalisation to end, we had one on the EU, and so they took what they could.
> The typical profile of a brexiteer is somebody retired, not somebody in employment
I find this slightly weird stated so definitively having just argued I was being simplistic. I'll lay my cards on the table. I'm British but took advantage of free movement, so I've been party to more conversations on brexit than I really care to think about both back in the UK and here. Trust me, however, this is not an accurate statement: there are plenty of people with jobs who voted for brexit and have strong opinions on it. You don't need to take my anecdata on it though, we can look at a study https://yougov.co.uk/topics/politics/articles-reports/2016/0... - to put this into words:
- of every 100 18-24 year olds who voted, 29 of them voted leave. - of every 100 25-49 year olds you meet, 46 of them will be leave voters. - of every 100 people retirement age or above 36 in 100 you meet will have voted remain.
I find the 25-49 year old bracket overly broad, personally. The vote flips at 50+, but I suspect it would flip slightly younger based on my own experience.
But either way, it can't categorically be stated that all brexiteers are retired people. Actually I can lay further cards on the table: I used to do statistics as a job. So I take issue with the phrase "older people with fewer qualifications most likely to have voted brexit" used on the table I am quoting. Older people yes, but age also correlates with access to education, since my grandparents left school at 15, so there's a significant confounding factor here. I'd be interested in a more detailed breakdown, and I find the "and uneducated" part to be problematic/needing more evidence.
To come back to my point, I was offering a very qualitative interpretation of an extra factor I think encouraged previously core labour voters (in places that have returned labour MPs for about as long as there has been a labour party to choose) to switch allegiances in 2019. I agree with the fact labour does not represent them any longer. Brexit is part of, but not all of, that: I'm adding that Labour had an unclear stance on brexit, whereas these regions tended to vote more strongly for brexit.
This is obviously my opinion only, offered without guarantee or warranty.
https://www.theguardian.com/commentisfree/2022/may/10/starme...
I know this is brushed off or denied by the intelligentsia, and I know the ruling class (no matter what the party) never worked for the interests of the people but themselves, but nevertheless the working class is turning to conservative politics. The really sad thing is very few people on the left seem to be honestly asking why. What is their party doing so wrong that the least advantaged working class is voting for the parties traditionally associated with capital? Instead they seem happy making up feel-good stories about "the horrible uneducated racists voting against their own interest" to tell one another, and that is about the extent of their intellectual curiosity on the matter.
Now that all of those votes go to the SNP it makes it extremely difficult for Labour to get a majority in the Commons along traditional ideological lines. There just aren't enough swing seats elsewhere to really make up for it. 200 seats haven't changed hands since WW2.
Seats gained/lost by winning party in elections since 1966:
1966: Labour Win, 47
1970: Conservative Win: 77
1974: Labour Win: 14
1979: Conservative Win: 62
1983: Conservative Win: 58
1987: Conservative Win: -21
1992: Conservative Win: -40
1997: Labour Win: 145
2001: Labour Win: -6
2005: Labour Win: -48
2010: Conservative Win: 96
2015: Conservative Win: 24
2017: Conservative Win: -13
2019: Conservative Win: 48
Current Seat Breakdown:
Conservative: 357
Labour: 200
SNP: 44
Lib Dem: 14
Plaid Cymru: 3
Alba: 2
Green Party: 1
NI parties: 18 (never been held by Labour or Conservative as far as I'm aware)
Speaker: 1 (politically neutral so irrelevant)
If SNP and Alba (Scottish Parties) are taken out of the equation entirely the way Northern Ireland currently is, Labour has only 18 seats that aren't held by Tories that they could potentially win. 326 seats are needed for a majority. That means Labour, in a best case (and very unrealistic) scenario where they gain all the seats from the minority parties, would need to gain 126 seats, with 108 of them coming from Tory seats in order to form a majority government.
I don't have the data going back past 1966 but looking at what we do have, a seat gain of more than 100 has only happened once: Tony Blair's 1997 win with 145 seats gained. 7 of those gained seats were in Scotland but Labour already held 49. In 1997, Scotland had 72 Westminster MPs but today, due to the redrawing of boundaries, it now only has 59. In total, Labour had 56 seats in Scotland. This means Labour held 78% of Scottish seats, which would equate to 46 seats today.
This is the real reason why Labour has had to become more and more Tory. To make up the deficit they either need to win back seats from the completely dominant Scottish National Party or win Conservative strongholds. They see the latter as more realistic so it's become their focus. When Scotland's seats are essentially out of reach of Labour, the UK becomes a de facto 1 party Conservative state.
It is absolutely bizarre to me that Labour won't make proportional representation and cross party co-operation a key part of their platform. Unless there are some seriously major shifts I can only really see Labour gaining power again through a minority/coalition government. Even if another right wing party such as the Brexit party emerged to splinter votes from the tories, Labour is still looking at a minority government. They simply can't gain enough seats unless they win back Scotland. This is why they are so reluctant to engage with the SNP because if Scotland really does leave the union, Labour probably won't be seeing power again unless there's electoral reform, a revolution or the tories mess up something up so badly that literally millions die. But by that point, they will have probably been in power so long (and absolute power corrupts absolutely) that they'll have the elections rigged autocracy style so even that may not matter.
https://www.electoral-reform.org.uk/latest-news-and-research...
https://www.independent.co.uk/news/uk/politics/jeremy-hunt-p...
The NHS has collapsed since COVID. No, it isn't due to lack of funding, that's a lie. NHS funding has increased massively under the Conservatives who haven't talked about even limited privatisation for the last decade or more. The reason it collapsed is that rigid commands and control systems cannot cope with change and the NHS was already dysfunctional before that. When they emptied the hospitals they created a massive backlog that they already knew they could never catch up on even with more funding.
At any rate it's irrelevant. The excess deaths are much more likely to be vaccine linked despite the collapsed state of the NHS. The timing, causes of death and split between vaxxed and unvaxxed doesn't really work for the theory it's lockdown caused.
Still, while waiting for patients to die is an cheap way to shorten backlogs, it does leave not instill confidence…
I agree a 3 year wait is unacceptable, but 2 years of that was covid. Covid has largely passed so they are now getting through the backlog.
That is simply not true. The Conservatives came to power in 2010. Here's what the The King's Fund [1] has to say on funding:
"In the decade following the global financial crisis in 2008, the health service faced the most prolonged spending squeeze in its history: between 2009/10 and 2018/19 health spending increased by an average of just 1.5% per year in real terms, compared to a long-term average increase of 3.6 per cent per year. These pressures were not unique to the UK, whose public spending on health care as a share of GDP is above the EU average, though lower than several comparable nations, including Germany, France, Denmark and the Netherlands." (Source: https://www.kingsfund.org.uk/projects/positions/nhs-funding)
[1] The The King's Fund is an independent charitable organisation working to improve health and care in England.
In the same decade the proportion of people aged 65+ increased from 16% to 22%ish of the population, an increase of a third. Since these are the people who consume the vast majority of NHS resource, the actual age-adjusted funding has been shrinking steadily every year.
Any discussion of the NHS budget has to accept this reality - the British state is already deep in deficit for decades and had built up incredible debts just trying to keep the NHS budget rising, which it always has. To say the NHS would works better with more money is simply to admit it's broken and can't be fixed, because the government can't even afford the current levels. Especially not after the attempts to stop COVID blew debt and inflation through the roof.
NHS apologists always seem to try this switcheroo: someone will point out NHS funding has massively increased - an objectively true claim - and then they'll be accused of lying, by someone who claims it's "underfunded", an entirely subjective and different claim. As you point out, both can be true, but the latter is not disproof of the former nor even a well defined statement.
That definitely sounds like the thread was talking about underfunding/lack of funding to me.
Also, for what it's worth, I think your use of "massively" carries an implication to the reader that funding has increased above and beyond maintenance levels (i.e. that it's gone up in real terms, compared to inflation and demographic changes), as I think most people wouldn't describe increases that are below the level needed to maintain service relative to costs as being "massive increases". You'd probably get less pushback if you described it as "increased in absolute terms", or specifically pointed out that the funding increases have been lower than the underlying cost increases.
I know you did eventually add the "in absolute terms" part, but perhaps consider starting with that next time.
https://news.ycombinator.com/item?id=32540740
"I think your use of massively carries an implication to the reader that funding has increased above and beyond maintenance levels"
The word massive here just means a massive amount of money relative to other levels of government spending changes. From 2010-2020 most govt departments got budgets that went down (austerity), but the NHS was excluded and its funding continued to increase. The amount of money it got is truly massive even on the scale of government.
Trying to talk about "real terms" or "maintenance levels" with something like the NHS is impossible because demand for healthcare constantly increases even with a stable population demographic (some speculate that healthcare demand is actually infinite), as does demand for increased wages. History has shown that there is simply no level of funding increase that the NHS's supporters would ever consider sufficient because they can always claim that the system is strained, could use more people, better paid people, the latest treatments etc. So there's no fixed level that can be identified as maintenance, as one person's maintenance is another's underfunding, which is why all claims about underfunding are impossible to argue with - the statement is literally meaningless.
Related problem: enormous sums of money get allocated to it at a time when every other service gets cuts, explicitly earmarked for upgrades to capacity or buildings and it all gets immediately spent on pay rises in blatant defiance of direct government instructions. So service capacity doesn't change at all but govt can't do anything because too many voters worship the NHS and assume it's perfect except for lack of money.
I know the most ardent antivaxxers are going to explain every death in the next 30 years by the vaxx ; but the numbers would be so staggering that I suspect plain old counting would help.
In same vein the "every death" (or hospitalization) during the covid pandemic was due to covid and/or lack of vaccination.
I add quotation marks because in both cases I do not believe it's true.
https://nakedemperor.substack.com/p/massive-increases-in-exc...
A lot of it is due cardiac reasons. You can also look at when excess death went up in younger age ranges that weren't affected by COVID and see that it starts at the same time the vaccine programme reached them. Hard to explain as lockdowns given they'd been happening for a year by that time.
Edit: Here we go. here's an analysis of deaths by vaccine status for the UK:
https://bartram.substack.com/p/deaths-by-vaccination-status-...
N.b. The way you calculate the population size heavily affects the meaning of this data and the government itself doesn't know what the population is, so there's plenty to debate here, but you can see why the author concludes there should be an investigation. He uses a conservative pop estimate based on official NHS registrations (because the ons estimate is definitely wrong) and plots the graph of the difference by status at the end. So you can set that for everyone under 75 the vaccines appear to be making things worse not better.
You walked right into it.
What makes you think private business are capable of delivering something cheaper than what the government can do? The most expensive health care in the world is private.
IE they had to provide care to everyone at a reasonable price.
I'm deeply suspicious of healthcare that gets to exclude people for cost reasons.
I too can provide great healthcare if everyone is mandated to pay me for my services and I get to exclude those I treat, that's a great business, the healthy pay and I exclude the sick, what wonderful pure profit business!
The insurance model bothers me for that reason, they really shouldn't be allowed to exclude anyone, if they're taking on the business of healthcare, then that's that, they are providing a utility service, which means they supply to everyone and they make money by spreading the cost between everyone.
There are nuances to that, but practically that's the goal they should aspire to, but unfortunately that model isn't the most profitable.
I mean take a look at the original US health insurance that existed:
> The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally [0]
That insurance model worked, it just happened to get outcompeted by entities who were willing to undercut them by aiming to capture only the most healthy people, which is in effect a tragedy of the commons.
Which is a real problem in my book, I'd be fascinated to see what innovations a private company could come up with under that model. We might have missed out on a whole slew of interesting ideas if we kept going down that route, which would still have been a pretty profitable business and would have been a great success for those who do believe that the private space can do healthcare better.
As it stands I don't believe the current private model meets that criteria as it fails at the first hurdle of being a health care service, it doesn't care about health.
So it seems like the choices are bad private care, good public care and bad public care. So yea, I'm leaning to the good public care.
- [0]: https://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Associa...
E.g. saying a state-run car company would've done better because all that profit money would've been perfectly allocated is not right. Otherwise the government's perfect decision-makers would be starting car companies left and right and making a fortune, instead of working for the government.
In things that affect your health, I don't want to be the guinea pig that discovers the service I paid for wasn't up to standard. That provider may go bust in the long run, but in the meantime will do a lot of damage.
"Bob Lutz compares Tesla to socialism after GM took $11B from taxpayers under his reign"
https://electrek.co/2016/08/18/bob-lutz-compares-tesla-socia...
I agree that cars are much better than they were 10 years ago. Thanks mostly to government regulations that the incumbent industry fought strongly, while Chinese state owned firms were taking advantage of the opportunity.
Roads aren't cars? I'm not saying that central planning is never a good idea, just that it's mostly not a good idea. "Where to put roads that a private company will build" is a reasonable role of government in a capitalist society.
> and then getting bailed out
I don't think they should've been bailed out. That was politicians buying car worker votes by doing politician things, like inflating the currency to make everyone's wages worth less.
Cars are better not mostly because of regulations, but because of manufacturing improvements, electronic/chip hardware and software improvements, and, most of all, competition.
The more-well-off also think Tory policies will get them a house and security. In practice, the UK housing market is completely fucked and gets more so every year, but... it doesn't stop people believing it.
Basically the health of the NHS is about the tenth thing on some people's minds when voting, until they get cancer or break an arm, at which point they start complaining about it.
Clearly the solution is probably somewhere in between, but political polarization has simply pushed people to their party lines and entrenched their positions such that no real progress can happen while things continue to fall apart.
So when you say:
> It never had a great track record to begin with.
Are you talking about government institutions in general or the NHS? I maybe wrong, but I suspect you're speaking of US institutions which are an entirely different dynamic to UK and European ones.
If you are speaking of the NHS, then please outline how it doesn't have a great track record commensurate with its lifespan.
I know the demographics in the US has vastly changed some cost models over that time, making some earlier social program hit major funding problems through no evil from govt actors.
There's a lot of thinking and work that goes on to cover working out the changing needs of your population that has to be handled by any well managed healthcare service.
In the NHS specifically I am aware that they also have change management procedures that exist to try and understand how to provide continuous improvement as needs and situation change.
That's not to say things are perfect, by any stretch of the imagination. For example the NHS still has a big blindspot when it comes to tech. Most people aren't willing to take the effective pay-cut of being a techie and working in the NHS, a lot of people inside the service don't really respect people with tech skills and there's still a bit of a holdover of not paying much for anyone that isn't a doctor.
That's not to say the situation remains static, some doctors for example are slowly accumulating tech skills as a result, so what will probably happen is that success for a tech person in the NHS is going to require a prerequisite medical degree, at least in the near term.
Which though I don't think it's the best strategy, I can't also argue it's a terrible one to expect people who provide tech services into the NHS have a reasonably high level of domain knowledge.
This is a large institution with a substantial mandate, we should expect to pay a reasonable amount proportional to what it provides us. The fact that it's substantially cheaper than other healthcare services while still providing a very high quality of care leads me to believe that it's doing a pretty good job meeting that mandate.
So I don't think blindly questioning it without taking such things into account is helpful, nor do I think that pointing to costs as being "too high" are helpful without considering what is happening and why they are being paid for in the first place. Chesterton's fence and all that, it's not enough to just cut costs, you have to ask what doing so gains you. There are too many social programs which we cut because "spending less is good" without asking if the spending actually gives us a positive return as a society.
Personally, I think we've become a little too tech obsessed in thinking every problem can be solved with IT. Digitizing records only feeds a surveillance state anyway and can be dangerous (for other, obvious, reasons).
Healhchare is tricky, because treatments are not one-size-fits-all. Large institutions are rigidly setup to deliver a product, a product that is ever changing, as new treatments are always being refined and added. When it was created it was set up to deliver products that were new 50 years ago, but the structure is inherently slow to evolve. But the private health insurance in UK does not have these problems. More effort could be made at growing the economy in such a way that rising incomes allow people to purchase the private health insurance. It's not an immediate answer for many, but it definitely beats throwing more money at a bureaucracy that cannot adapt.
Here's how you do it: you pump unsustainable amounts of money into the service over time. This allows you to offer a great service until in the future you can't pump enough money into it anymore. But that's a problem for the future generations. Those future generations were funding the previous generations all the while, but won't get the same benefits themselves.
An ever increasing percentage of GDP is being poured into the UK's NHS. At some point it's going to be too costly and the young generation at that time will have to pay for it, but won't get the same level of service themselves when they're older. They will be the ones left holding the bag.
I don't think there's a politically viable solution to this though. The problem with this model is that you're effectively borrowing from future generations, but the system takes so long to reach actual unsustainability that people will grow up with the feeling that the system is great.
>you pump unsustainable amounts of money into the service over time. This allows you to offer a great service until in the future you can't pump enough money into it anymore.
This is how every growth based juggernaut business works as well. Quality of service always goes down to continue growth of profits, especially after you've crushed the competition.
IMO, healthcare of the public should not be a profitable business. Or the business will always find ways to squeeze their customers who simply need care for the health.
https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...
Don't forget healthcare isn't about you, it is about society and if you don't care about society just think of it instead as having healthy employees and customers, who aren't ruined if they fall ill, and therefore have cash to spend...
Basically, libertarians are just wrong on this. Government-run health care works great and we have many decades of evidence showing that.
I don’t think they are comparable. Medicare exists because private insurers refuse to cover old people at a reasonable price. It’s a good scam the private insurers have going: take peoples money when they are generally healthy and productive, drop them like a sack of shit onto the government’s lap when they aren’t.
That is why the life expectancy of the average obese, unhealthy American is about the same as the life expectancy of the average (much healthier) Japanese or European person. Americans are allowed to eat their way to an early grave and then have medical resources thrown at them to desperately keep them alive a few days longer.
EDIT: Also, I should point out that doctors generally demand a lot less end-of-life care than members of the general US population. They seem to understand that it is merely prolonging the inevitable rather than helping.
These are not measures of efficiency. Medicare outlays are about 30-40% of private insurance for the same demographics.
> the care that people get from Medicare is substantially worse than what you get from private insurance
And this is, in fact, not true at all. US citizens on medicare beat their cohorts not only vs. other nations but vs. private insurance in the US too. Don't make the mistake of comparing your corporate insurance for a workforce with a median age of 30 with what retirees in the private market have available.
Retirees on the private market get completely shafted, though: almost everybody in their age group uses medicare, so the insurance will need very high premiums to cover their risks. From what I have heard, people who are on employer plans at that age have better health outcomes than retirees, regardless of where the retiree gets their healthcare.