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Comment by dijit | Hacker News Reader

I read a paper in 2016 that was attempting to understand if there was a human cost to Austerity.

They succeeded in finding a causal link between austerity measures and increased mortality.

At the end of the paper they estimated that 120,000+ people have died as a result. Additionally: that the the rate of excess deaths was increasing year on year.

There is an issue with highlighting this;

For starters, many people are very likely to bury their heads in the sand:

* "How do you know that it's related to Austerity" (not reading the paper)

* "They would have died anyway"

* "The world is different from the time period it is modelled from" (it corrects for this by comparing also to other roughly equivalent economies)

* "The UK is different than other advanced economies!"

The other issue is that it sounds so insane and conspiratorial.

120,000 is a large number. It's approximately the size of Stratford upon Avon.

A follow up study puts the number now closer to 330,000, around the population of Coventry.

Somehow people will blame the NHS for not being efficient, though evidence to the contrary exists throughout its history, often being one of the most cost effective healthcare systems in operation; or that COVID is a contributing cause to these figures.

People are unwilling to hear this: This was a problem well before the pandemic.

Source (2017): https://bmjopen.bmj.com/content/7/11/e017722

Source (2022): https://www.gla.ac.uk/news/headline_885099_en.html

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Both underfunding and overfunding can cause inefficiencies, there is a sweet spot in the middle where an organisation would be at its most efficient.

It's quite clear that the NHS has been underfunded, and under resourced, for the last decade. However the government still try to argue that the inefficiencies are a organisational problem rather than a funding problem. Which is still laughable when they have presided over it during the whole time period in question.

And to be clear if you have an overfunded health system then you are providing good medical treatment to your population in a timely manner. You're just spending more money doing it than you might otherwise do so.

So someone with ethics might argue that if you are in an uncertain area between over and underfunding then it will kill fewer people to err on overfunding.

Overfunding doesn't always result in effective or good service/products.

If management doesn't flow the extra funding to front line staff or resources, it can easily be wasted for zero added value.

Which is exactly how the semi-privatised NHS operates. Agencies have been encouraged to set up as independent service providers who can profiteer by price gouging the NHS while paying nurses and doctors pocket money.

Renationalising the NHS and limiting the private sector to those few expensive services that are essential would fix this.

But both political parties are working for the people who profit from this situation.

They would be better off addressing the root causes that are sending more and more people to the NHS in the first place. Healthy food needs to be cheaper than unhealthy food, physical exercise needs to be encouraged at a grass roots level, working conditions need a massive overhaul, education needs to improve, salaries need to rise and/or rents need to fall, and housing needs to be of better quality, particularly around insulation. At the minute we’re treating the symptoms and not the cause of the disease.

Not necessarily: my understanding is that in the US a few people probably get more healthcare than the optimum, and many get less, all on an extremely large budget.

Yes you're correct. I'm not sure I can fix my definition. Would probably have to rip it up and start again.

Something involving killing patients if you don't build some leeway into the system.

What does overfunded even mean for a health system? Some patients with serious complex conditions can consume an effectively infinite amount of healthcare services, especially if we want to take heroic measures to keep them alive a bit longer. I don't think there is any amount of funding that could realistically be put in that would make the UK NHS overfunded; you can only compare funding and outcomes relative to other developed countries.

The "funding" problem that I never see discussed is that the NHS costs massively more per-person now than when it was introduced.

ex. How many ambulances at a few pounds in 1948, which were vans with a stretcher in the back and a couple of blokes to drive it. What about 2022? The cost, roughly £150K for the ambulance, goodness knows what to train up ambulance technicians and paramedics. If the kit is broken, the ambulance can be out of service, which means more units to provide cover (or not if you can't afford it!). The on top of all that, many more people go to hospital because the care is leagues above what you got in 1948.

Ditto for equipment costs like Digital XRays, MRIS etc.

All of that is not surprising or even undesirable but it would be interesting to see the additional tax that you should be taking per-person to pay for all of this additional equipment. If the NHS costs around 30% of expenditure i.e. 30% of my tax then roughly 7.5% of my income covers the cost of the NHS, maybe £6K per year. When we look at things that way, you can see why the Government doesn't want to take any money in tax because that sounds like a lot of money. You can also see how they can't reduce costs by going backwards in replacing high-tech with no-tech.

It wouldn't need any more tax. There's a black hole in the budget caused by inefficient tax collection, almost entirely to the benefit of large corporations and very high net worth individuals.

There are also some quite ridiculous cash handouts for little or no taxpayer benefit. Like the notorious £37bn that failed to provide an efficient Covid test and trace system. Or the >£100m in the Michelle Mone scandal, which seems to have been just one of many. Or the £45bn in tax cuts in Kwasi Kwarteng's recent budget, which were supposed to "promote growth" but have done the opposite.

The UK is one of the richest countries in the world. It has also become one of the most corrupt.

A penny or two on tax is not the problem.

> It wouldn't need any more tax.

i don’t think you realise how much the health service costs. you can tax all of the richest and it will represent a few days of the health budget. a new funding model is needed. otherwise there will have to be tax increases.

The Kwasi Kwarteng tax cuts were all reversed by Jeremy Hunt, I thought?

The NHS also costs more now because the population is sicker than in 1948. Older, fatter, more sedentary, heavily impacted by preventable chronic diseases. Demand for services is way up. Higher taxes might help a little but won't address the root cause.

From what I read it’s not the equipment, but a bloated layer of bureaucratic management on massive salaries that is the real issue. The front line staff get pittance in comparison.

NHS management overhead takes up approximately 8% of the total NHS budget [1] In the US that number is more like 15-20% [2].

[1] https://www.kingsfund.org.uk/projects/health-and-social-care... [2] https://jamanetwork.com/journals/jama/fullarticle/2785479

> It is extremely difficult to find an accurate figure for the number of managers in the NHS, and most sources of information use different definitions for who is counted as a manager.

I’m not sure I can take the report seriously after that. You can’t write a report on management in the NHS and refuse to give a definition of manager. Also, how many of these managers are directly employed by the NHS and how many are employed as consultants?

I’m not saying you’re necessarily wrong but that report is hand wavey.

The Kings Fund is a credible source of information about the NHS systems in England, Scotland, Wales, and NI. One of the reasons that they're credible is because they're cautious about definitions. In your quote they're saying "lots of people have written about this, and they all use slightly different definitions for management, and so they all give different numbers".

What is a manager? Are you only including non-clinical staff? Or do clinical staff count too? If you're including clinical staff, how many hours of their working week are you counting as clinical hours and how many are you counting as managerial hours? Are you converting people who work part time as managers to Full Time Equivalent positions, or not?

If you want to poke the data it's here: https://digital.nhs.uk/data-and-information/publications/sta...

If you want more description of the complications of counting managers in the NHS I found these useful (if a bit old now):

https://www.kingsfund.org.uk/publications/future-leadership-...

https://www.kingsfund.org.uk/projects/general-election-2010/...

https://www.kingsfund.org.uk/projects/health-and-social-care...

Looking at the chart on https://www.kingsfund.org.uk/projects/general-election-2010/... it looks like consultants are taking more than their fair share

Thank you I will look into this.

I think that's the problem with "what I read". I think the "man on the street" would probably agree but not necessarily from hard data, just from the fact it is easy to blame inefficiency rather than structural or human problems.

"The NHS is full of bureaucracy" but it is a bureaucratic system so of course it is. People to charge hospital costs back to GPs, people to investigate trends and make sure that some GPs are not under-referring people to hospital, etc. but when I worked in the NHS many moons ago, it didn't seem particularly disproportionate to the size of the organisation. There were many more problems with people not doing their jobs properly but that was everyone, not just this nebulous "middle management" that everyone likes to cite!

Certainly, some hospitals under-perform and have issues with culture and discipline but that's the same as any business.

> Both underfunding and overfunding can cause inefficiencies, there is a sweet spot in the middle where an organisation would be at its most efficient.

I can't help but think that efficiency should be a secondary metric when it comes to health care. If you can get the same treatment, capacity, resilence etc. cheaper, go for it – sure. But as soon as you start to save money by sacrificing those more important metrics the price will be paid in human lifes eventually.

Every society has limited resources that it can afford to spend on healthcare, regardless of whether that funding comes from public or private sources. It is simply impossible to deliver unlimited, high-quality care to everyone. So, if we want to do the greatest good for the greatest number of people then the only option is to maximize efficiency.

> It is simply impossible to deliver unlimited, high-quality care to everyone.

Anything "unlimited" is impossible in a constrained physical world. So I am not sure what contribution you like to make by stating the obvious here.

For most economies delivering reasonable high quality care to everyone who needs it is totally a thing they can (and in some cases: do) afford. It is just a matter of priorities. You would be surprising what nations can sustain if they really want it. War is a good example. When a nation goes into a long war and changes its economy to support that war we call that a war-economy. It is an economy, that priorizes a lot of what it produces and outputs for the war effort. Nations can be years or even decades in war-economy mode without going under and that works because they priorize the nations existence (and thus the war) above other financial goals. And in war nations also make companies do things that would be otherwise unthinkable, e.g. make a company share blueprints with a competitor, favour certain industries with resources, etc. If any nation knows that, it would be the UK.

So if any modern western government goes all cheap and naive big eyes on health care, it is not because they can't do better, but because they don't want to. Not wanting to do better is a very easy opinion to have, especially if one earns money by being of that opinion. Those who suffer and die are also a different demographic than them, so even easier to pretend all is going well.

I am not saying that any health care system should be inefficient. It should be efficient in certain way (e.g. prevent funneling government money into pockets, prevent paying too much for medicine and equipment and so on). But efficieny is not the primary goal here, the primary goal is to have an adequate health care system. And you will always get unethical rich people saying private payer is adequate, because THEY are covered by it. But the fact of the matter is that everybody profits when a nation has a good working health care system for all, even the rich egomaniacs. After all they cannot decide where they will have a medical emergency as well.

Austerity IIUC is more about reducing the deficit than reducing spending.

Usually the way you achieve this is by reducing spending to reduce the deficit.

But you could also increase taxes.

Government spending will eventually be paid. It's whether it gets by the people now, the people in the future, or the bagholders (bond holders when the government or currency collapses).

Of course life expectancy is going to decline if you can't force your grandchildren to pay for your healthcare costs now.

But it's not clear to me that's the most evil thing in the world.

Back when most spending was infrastructure and growth was high, you could argue this would be around forever, and it should be financed to a large degree on future generations.

But now that a huge percentage of spending is entitlements and growth has slowed, it's less clear.

The thing about austerity, though, is that by reducing spending you also shrink the wider economy, reducing tax receipts. The "nation's credit card" rhetoric the government has used to try to justify this is just misleading.

Oxford prof Simon Wren-Lewis explains it better than I could: https://www.lrb.co.uk/the-paper/v37/n04/simon-wren-lewis/the...

In the case of the UK and NHS, under/overfunding doesn't quite capture the whole issue. The nature of spending matters, too. More spending on capital and managerial expertise could help improve things, but has largely been neglected due to political concerns regarding efficiency (or, perhaps, perceived efficiency).

The NHS is also suffering as a result of other departments' cutbacks: https://www.theguardian.com/society/2022/nov/13/hospital-bed...

The tl;dr here is that there's a striking number of patients in hospitals (up to 30% in some areas) which are ready to be discharged from hospital, but cannot yet be discharged since they're waiting for the availability of social services that aren't handled by the NHS. I've mentioned it in all my comments here but this is the cost of austerity, and it's making healthcare not just worse but more expensive.

The NHS is just a government department run by the UK Health Minister. Always point the finger at the person holding the purse strings and the person controlling the laws and policies.

The best time to start training more doctors and nurses is ten years ago. The second best time is today.

If only there were a decentralized system where consumers and service providers could allocate resources according to their value preferences by providing voluntary incentives.

You're referring to the US system of private insurers and healthcare providers which leaves millions without any access to healthcare and can result in bankruptcy as a result of an illness or accident? And which costs more per-capita for worse outcomes?

I'll take an adequately funded NHS, thanks.

Pretty sure that is NOT what the parent comment was talking about. The US system has all the problems of a government run health system (which it basically is at this point) but none of the benefits. There are absolutely zero market dynamics at play in the US Health system any more.

>> leaves millions without any access to healthcare

Absolutely, 100% completely false.

>>can result in bankruptcy as a result of an illness or accident

This is true, however contrary to the social stigma bankruptcy can be a good thing for many. In the US Medial Bankruptcy is often made inevitable by various government regulations that prohibit creative solutions by providers.

> Absolutely, 100% completely false.

Ok I'll be more specific: "leaves millions without insurance and since they're usually low-income and therefore cash-poor, unable to get any adequate access to healthcare". Is that really, meaningfully any different from what I said?

I have to say, the words "bankruptcy can be a good thing" is going to be bouncing around my head for a while. I don't know how less regulation could help these people, and I'm a little bit horrified thinking what kind of creative solutions these providers would come up with ...

The low-income are eligible for Medicaid.

>Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017,[3][4][5] as well as paying for half of all U.S. births in 2019.[6] It is a means-tested program that is jointly funded by the state and federal governments and managed by the states,[7] with each state currently having broad leeway to determine who is eligible for its implementation of the program. As of 2017, the total annual cost of Medicaid was just over $600 billion, of which the federal government contributed $375 billion and states an additional $230 billion.[6] States are not required to participate in the program, although all have since 1982. In general, Medicaid recipients must be U.S. citizens or qualified non-citizens, and may include low-income adults, their children, and people with certain disabilities.[8] Along with Medicare, Tricare, and ChampVA, Medicaid is one of the four government-sponsored medical insurance programs in the United States.

https://en.wikipedia.org/wiki/Medicaid

Great start. Expand it

>>"leaves millions without insurance and since they're usually low-income and therefore cash-poor

This is still false, infact the most impacted group by medical costs is the Middle Class not the poor. People too "rich" to be on public assistance programs like Medicade but too poor to afford a medical emergency and work for employers that either do not offer insurance, or have poor coverage.

>>the words "bankruptcy can be a good thing" is going to be bouncing around my head for a while.

I have known more than a few people that have gone through bankruptcy and it was the best thing they could have ever done. One mistake people often make is waiting tooo long to declare bankruptcy. Bankrupcy is a legal tool designed to provide aid to people who find themselves in too much debt, there are all kinds of things built into that system to assit people. It really is not a punishment. For example most people do not realize that they can Keep their primary residence and primary transportation even after declared Bankrupcy. People have this vision that is you file for Bankrupcy *protection* the police are going to come take all your things and put you on the street.

>>I'm a little bit horrified thinking what kind of creative solutions these providers would come up with ...

One thing that is prevented by Regulation is Medical Coop's several have been tried but they can not navigate the regulations to make them workable. Non-profit Member owned Coops would be a great thing for medicine, just has it did for Utilities in many regions of the US.

When even companies like Walmart can not make low cost medical services work directly as a result of regulation you know there is an issue.

You're dancing around the issue: you shouldn't need to have that debt, regardless of how spiritually cleansing you think the bankruptcy process might be. If you'd asked the people who went through it whether they'd rather a national insurer handle , I am sure they would have far preferred that. I'm quite shocked you know multiple people have had this kind of medical debt and can still come back with the bankruptcy-is-good-actually line.

I kind of feel like you're trolling me a bit, if I'm honest.

>>you shouldn't need to have that debt,

Why?

Or I guess I should ask what other requirements of life should be completely under the governments control? Should Government run farms and give you food for free? Should government build homes and issue them to people?

I have never been clear why healthcare is uniquely something that must be provided by government but other things are not.

If you think the government should provide everything you need to live like they were a parent or nanny well then we have completely and incompatible views as to what a government should be

> Should Government run farms and give you food for free?

The government do provide assistance for food for those in need, and they are right to.

> Should government build homes and issue them to people?

Local governments in most developed countries build homes and issue them to the needy. And I believe this is correct.

You've obviously deployed exaggeration to try to make these things sound ridiculous ("...completely under the governments control..." and "...live like they were a parent or nanny...") but really none of this is controversial, they're pretty common, mainstream beliefs.

I believe that a government should work to better the lives of the citizens it governs. This includes things like providing education, healthcare, road and rail infrastructure among other things you probably wouldn't like. I am quite sure we have incompatible views as to what government should be and that we both believe the other's vision of an "ideal" country would actually be a dystopia. However some of the happiest, healthiest and best-educated countries operate pretty close to my ideal.

>>The government do provide assistance for food for those in need, and they are right to.

This is always the comeback to that question. The US provides food assitance and Medical Care Assitance to low income people via many many many government programs, very expensive government programs

That is NOT the same thing as NHS, which completely takes over and provides the care. Food Assistance gives people with out income money to go buy the resources on the open market. Medicade gives people with out income money to go by resorces on the very regulated US health system

This is not an analog to NHS or other government run single payer health systems

So again I ask, not about providing social safety net, but should the government completely take over farming and housing like the NHS and other government provided programs do for health services

>>This includes things like providing education, healthcare, road and rail infrastructure among other things you probably wouldn't like

Correct, Government is incompetence personified. The incentives for government programs do not include providing quality services at the most value. Driving on my roads, going to the government schools I went to, and seeing first hand what "government housing" is has cemented the fact that government provides poor quality services at extremely high costs

>>However some of the happiest, healthiest and best-educated countries operate pretty close to my ideal.

That is very debatable, and not really supported by hard data

> That is NOT the same thing as NHS, which completely takes over and provides the care.

There's loads of reasons to dislike NHS care and it's genuinely weird that people who are so against the NHS never manage to hit on something real, and instead resort to stuff that's simply fiction.

NHS England spends billions commissioning care from private providers. That's why we have Priory Group, Cygnet, Operose, etc etc all providing care. (And in the case of cygnet and priory, often poor quality care).

And patients have a right to chose where to get their care - that's what chose and book is.

People who don't understand the NHS think it's a single organisation -which is what you've done here- and that's not correct. Patients have a choice of where they get elective care. NHS England commissions specialist services, and 42 ICSs commission the bulk of regular services. They're not allowed by law to have a preference for NHS providers, so if a private provider can do it for the money they should put a bid in. That commissioned care is provided by about 200 - 220 NHS trusts. NHS Trusts include ambo services, acute hospitals, community hospitals, mental health care, and community care. These NHS trusts are independent organisations that have their own boards of directors and their own accounts and they can compete against each other to provide services to particular regions. This does not include primary care which is provided by GP surgeries.

So the criticism here is when talking about "The NHS" as a free-at-the-point-of-use system, I didn't also go into variety of contractors that are now involved and specifically the NHS Trusts that exist in NHS England which I have never encountered having spent 25 years of my life in Scotland so I can't really talk about personally?

And how exactly would that have improved this discussion with "phpisthebest" who seems to be against the very idea of insurance altogether, given that they have the means to take care of all their healthcare needs in cash (for now), and who thinks that everyone else should really see bankruptcy as a sort of spiritually cleansing and enriching experience?

> This does not include primary care which is provided by GP surgeries.

Which are and have always been private businesses operating as NHS contractors - this was actually the concession the post-war government had to make in order to get the British Medical Association onboard with the NHS. And recent surveys indicate GPs are against any change to their private status.

Ok fine I didn't realise you were trying to lay a couple of little heffalump traps, so instead I just answered what I thought made sense. The given analogies are clumsy and don't really fit ("run farms" is silly - the NHS doesn't produce all of the things involved in the provision of healthcare - medicines and such) but I will humour you and answer in the context of the UK:

> Should Government run farms and give you food for free?

Probably not, the existing system works ok enough. They can maybe help the poor a bit more so they're not dependent on food banks (free school lunches was a recent controversy that shouldn't have been)

> Should government build homes and issue them to people?

I answered and you didn't like this but - yes and they should build more. I'll give you a little bonus and answer what you wanted to ask - "Should the government be the sole central authority providing housing?". Probably not, the housing market works ok enough in general. However they can maybe help the poor a bit more by building more council housing, not doing so is has directly contributed to making housing unaffordable for many.

And to bring us back to the original topic:

> Should the government have setup a national healthcare system back in 1948?

Yes - in the wake of WW2 there was no existing, competitive alternative that served the needs of providing quality, affordable healthcare to the populace. The NHS went on to deliver and then some. Plus with ~70 years of hindsight we see that in spite of a decade+ of brutal austerity, the NHS still costs less and delivers better outcomes than privatised systems like the USA has. It was the right thing to do, it is the right thing to do.

Also you seem to think they’ve shut out private providers altogether. This isn’t true, private healthcare exists if you want quicker access to some elective or non-urgent procedures or treatments.

Re your final point - this is very interesting. I'd like to know what countries you think I'm talking about, and if your libertarian (I think I'm right in saying this?), small government setup is anywhere close to implemented somewher right now or if it's purely theoretical/fantasy.

> If you think the government should provide everything you need to live

If you're going to argue against fundamental human rights like "right to life" then you're going to have to do better than the arguments you're using here.

Perhaps we should check our premises.

Would you agree that subsidies and regulations increase prices?

Not necessarily

“Absolutely, 100% completely false.”

Perhaps virtually everyone has access to health care, but certainly millions opt out at the cost of their own well-being because they can’t afford it. There have been times in my life when I have.

People opt-out for a wide range of reasons, Take myself as an example. I largely opt out of care even though I have great insurance, and ample resources to afford it even if insurance did not cover it.

My reasons for opting out have nothing to do with finances, it would get exactly the same amount of care if it was free.

30 million American have no health coverage.

The common refrain is that they can go to a hospital, except an emergency room is not going to help chronic conditions.

Any idea that a majority of these people are choosing to have no coverage, goes against all research on this topic.

Exactly, both systems are imperfect, but I'll take the half functional one over the inhumane one that also discriminates and ruins people while making excessive profit.

>You're referring to the US system...

No, I'm not sure why this set of false alternatives keeps popping up. There's no need to read those implications into the comment. It was succinct and to the point.

Your comment hinted at a solution and I gave the closest example that most of us know - the US marketplace of private insurers. If you didn't want people guessing you could maybe have been more precise.

Make a law that hospitals must have menus. Pricing ought to be clear upfront, not negotiated through back channels.

What problem is this meant to address?

You mean like in the US, where half a million people are bankrupted by health care costs every year?

>According to the World Health Organization, US per capita government spending on health care is the fourth highest in the world.

https://fee.org/articles/the-idea-that-the-us-has-a-free-mar...

There's a lot of regulatory capture going on there. It's not exactly a free market.

You don't want it to be a free market. People who need urgent health interventions are not ordinary rational consumers. They may not even be conscious.

Combine this with providers incentivised to provide as much healthcare as possible at the highest possible markup, and insurers incentivised to deny as much care as they can ... and you have what always looks (from the other side of the Atlantic) like a gigantic life-and-death financial nightmare.

Life expectancy in the USA is significantly shorter than other first world countries with national health systems.

Given that the US healthcare system is similarly failing, I wouldn't be so snarky.

Decentralised systems have a horrible truth: they tend not to optimize for the problem they are set up for but for the thing that creates the greatest feedback loop. In case of a healthcare system inside a capitalist society, the system will optimise for profit maximalisation, this automatically means that a large group is cut out of care because: 1) they require too much care 2) they cannot bring enough money to the table

Its a simple fact of how markets work. A free market is just an ideal, just like democracy, open borders and justice. It is not some law of the universe. In fact: countries that profit most of their markets are countries that highly regulate them. These countries include the US, China, South Korea, Zwitserland, Norway and Dubai. But not: Mozambique, Venezuela, Sudan, Russia, Haïti. <-- these countries dont have functioning markets because there is too much unregulated behavior, too much corruption.

Wait you are honestly claiming that Venezuela is captialist nation? Really?

The once shining example of Socialism that has now collapsed as socialism always does is "capitalist" now that it has failed? that is rich right there.

Russia is more or less the same... A Collapsed socialist state that never really adopted free markets, sure they adopted some aspects of capitalism but only because after the inevitable collapse of socialist policies the people in power divided up all everything of value between themselves and their friends. That is not capitalism either.

Capitalism have nothing to do with free market, unless it changed meaning again?

Colloquial they are analogous in most conversations, used interchangeably in informal conversation

Ok, to me it's very different.

Free market is from the liberal ideology, and is like "well separated market with rationnal actors will take the most appropriate decision according to available information automatically". Basically.

Capitalism however: "an economic and political system in which a country's trade and industry are controlled by private owners for profit." And this is the Oxfor dictionnary definition because i don't want to misconstrue or be accused of bias.

I don't see how one replace another, in any situation. Sorry. You can very well have free market in a socialist country. More than that: in an anarchist country (which doesn't and would never exist, this is more than highly hypotetical), free market is the default and would need fewer regulation, as power in a market couldn't be leveraged to gain advantages in others.

>>. You can very well have free market in a socialist country.

you literally can not.

Free markets are one form Capitalism, All Free markets are Capitalistic, but not all Capitalist Systems are Free Markets. Other Capitalist non-free Market systems include things like Corporatism, Welfare State, Oligarchic, etc

And that can be manipulated by the limited elasticity of the system together with a good lack of transparency and competition?

The NHS pays doctors in money. It's not communism.

>The best time to start training more doctors and nurses is ten years ago. The second best time is today.

The comment seemed to be observing a failure in resource (medical professionals) allocation on the part of the central planners.

We don't need to get into the weeds of what is communism or neoliberal third-positionism.

https://en.wikipedia.org/wiki/Third_Way

GPs in the UK are private businesses and always have been lol.

Fascists are very often proponents of "the third way". Not saying you are a fascist, just adding some context to this. A little guilt by association.

I think the problem with the "third way" and with "communism" vs "neo-liberalism" is that they are all not focused on anything it's just a way to create a new "tribe". Conservation of Nature and worries about environmental decline used to be an elitist right wing conservative topic. Now its a leftist topic. Its not really about the topics, its about drawing lines in the sand and saying: "We from the left/right/third way, stand firmly behind this line! Who is with us?" It is just a way to define a group that can be used to gain power.

It is easier to distinguish between laissez-faire and the ideologies you listed. For me this seems to be a more meaningful distinction. Especially as it relates to the topic at hand. Central planning comes into play where the market is not allocating resources. Fallible men with imperfect information vs. aggregated price information.

I always love that the solution to all government failings is simply spending more tax dollars or incurring more debt....

Putting back the percentage of GDP that has been deallocated for the NHS would go a long way to solving the issues that were caused by the deallocation.

That seems pretty uncontroversial.

There is, however, a large contingent of private companies profiteering from this situation; as the NHS was forced to buy things from private hands.

More money will not fix this mandated profiteering.

Do you think we should have more doctors in the UK? You are aware of the bottlenecks preventing that from happening? Do you think that it's just a question of money?

Literally right now it’s being reported that 300-500 people are dying weekly just because of extreme delays to emergency medicine. It doesn’t take many years to rack up 120k deaths at that rate (though I recognise the study was prior to this collapse and references primarily more diffuse causes)

I posted a years ago about how austerity was an outcome of the misuse of Excel for problems of scale that it wasn't designed for. Once some researchers figured out the problem with the spreadsheet that these governments were using, almost all stopped with austerity policies, but the UK didn't.

I posted that there would likely be one of two outcomes - a lost decade, we'd be in a worse position and no one should ever again think that the Conservatives are economic masters compared to Labour again, or that George Osborne was a bona fide economic genius and the UK would come out of this extended austerity in a fitter and leaner state ready for the challenges ahead (ala early Thatcherism).

The answer is the the first one - we had the lost decade, are looking at potential second lost decade and we're now equivalent to a central European country not France.

The Conservatives deserve to die at the next general election for this and should be replaced by a completely new right of centre political party as the opposition.

Austerity wasn't even that austere. Government spending didn't even reduce.

https://www.statista.com/statistics/298465/government-spendi...

Really? Try these charts for size: https://twitter.com/henrywismayer/status/1612531409339711488

Meh. That's all relative to GDP. That's not a reduction.

Unrelated to the main article, but I do find it quite upsetting that the Liberal Democrats have been absolutely crucified by both the Conservative party and the Media.

I can't go very far in a discussion about the liberal democrats without hearing that they didn't follow through on a manifesto pledge.

Which is wild because in a minority government, where you're given the option of electoral reform or sticking to another manifesto pledge; you have to pick one.

You're a minority government! You can't do terribly much.

Then the most recent leader of the lib dems being crucified publicly for being religious in some manner, (tbf: he said "I think Homosexuality is a sin but I support equal rights; and everyone should live free and with dignity")

Yet, the Conservatives do much worse and face no indigence in votes.

It's baffling.

FD: I'm not terribly supportive of any particular political party, but Liberal Democrats is one of the "more supported" ones of mine, along with SNP and Greens.

My main quarrel was hypocrisy.

I assume by ‘breaking a manifesto promise’ you are referring to backtracking on the student loan issue. For context, the Lib Dems ran a campaign, the most talked about point being that they would get rid of student loan fees which had recently risen to £3000, the highest they had ever been. Not only did they not do that, within about two years of office they signed off on doubling that amount by 200% to £9000 tuition fees. For the average student, University tuition now costs even more than America (I can provide a source if you don’t believe this), and I would argue that the quality is nowhere near as good.

I voted for them on the basis of that pledge and I have never felt more betrayed by a political party in my life. It sickens me to my stomach. In this country you can only get four years of loans for university. I ended up dropping out of university because I was a mess in my late teens/early twenties. It means I now only have two years of funding left - not enough to get a degree unless I do a two year fast track course which are only available in certain subjects and of questionable quality. To go back, I would have to find a spare £9000 out of nowhere plus living costs which are most likely at least another £9000. This is particularly difficult when you can’t access high paying jobs because you don’t have a degree.

I’ve long since sorted myself out but I am now effectively priced out of bettering myself in my own country, directly as a response of the decision of this Lib Dem government. I taught myself to code to finally escape the minimum wage job trap. I have also been teaching myself Spanish over the last few years and I am seriously considering moving to Argentina or another Latin American country in order to access the affordable education. I am also going to start teaching myself German to open up the option of staying in Europe as the university costs there are minimal or free. Once I leave, I am planning on never coming back if I can help it. I feel that betrayed by my own country and have zero faith in it as a democratic representation of its citizens.

The Lib Dems could absolutely have not voted for that issue. They could have walked away and dissolved the coalition government. They chose not to. Well, decisions have consequences as I found out the hard way. And as a result, I will never vote Lib Dem again so long as I live.

And Labour invaded another sovereign country illegally and set a lot of the groundwork for this current problem of the NHS privitisations with "PFIs".

And the Conservatives are the ones who actually instrumented those policies you dislike.

Lib Dems went for electoral reform in the gambit of making it a more representative democracy; a gambit which lost.

"Give me your backing on this and I'll give you the other thing" is a pretty common compromise.

I'm sorry about your student loans, but were I in the same position, I would have made the same gambit.

Who do you vote for in that situation?

> And Labour invaded another sovereign country illegally and set a lot of the groundwork for this current problem of the NHS having to continually sell its assets (such as real estate).

Yes I don’t agree with the Iraq war. But Labour didn’t run an election campaign based on not going to war in Iraq before getting elected and then going to war in Iraq. Or in the case of what the Lib Dems did, going to war with Iraq plus another two countries on top (200% increase). Iraq had no part to play in the election. I can’t comment on the NHS part because I don’t know specifically what this ground work is you’re talking about.

> And the Conservatives are the ones who actually instrumented those policies you dislike.

This is bullshit, it was a minority coalition government, if both parties didn’t vote for it it wouldn’t have passed. The Lib Dems are equally as responsible as the tories.

> Lib Dems went for electoral reform in the gambit of making it a more representative democracy; a gambit which lost.

This is one take. The other is that the Lib Dems voted for what was in the best interest of the Lib Dems (had they have won) and dropped all their other principles and pledges to the people that voted for them.

All the parties are rotten but as I say, I will never vote for the Lib Dems because of the direct consequences their decisions have had on my life. And I don’t think that makes me a hypocrite.

Electoral reform has been central to the Lib Dems plank since they first formed, of course they were going to go for the one shot at it they were ever likely to get. I was pissed off with them at the time as well, but in hindsight I was pretty ignorant of most of their platform at the time, which meant it was my unrealistic expectations of them that were broken, nothing more.

Electoral reform was also an advertised manifesto pledge. A pretty huge one actually: "a fair deal by cleaning up politics".

My key point here is that, while I understand you feel betrayed, the other parties are quite literally breaking their pledges left and right.

The main difference is that it seems to get not that much media attention.

That you wouldn't vote for someone who made a compromise against their values: but might vote for a purported anti-semite[0] or an actual racist homophobe[1] is disquieting.

[0]: Corbyn being accused of being an anti-semite is of course a load of tosh spun by the right wing media machine

[1]: https://www.theguardian.com/politics/2017/sep/30/boris-johns... & https://www.independent.co.uk/news/uk/politics/boris-johnson... & the numerous comments regarding "letter boxes"

I don't care about the Liberal Democrats' manifesto pledges.

I do care that they enabled the Conservatives to impose austerity.

> The Conservatives deserve to die at the next general election for this and should be replaced by a completely new right of centre political party as the opposition.

The Lib Dems?

Important to note when people talk about "austerity" they don't mean cuts, but cuts in the future proposed spending increases. Public spending rarely goes down in absolute terms. Even as a percentage of GDP it doesn't really go down and certainly not since COVID

https://www.statista.com/statistics/298465/government-spendi...

https://tradingeconomics.com/united-kingdom/government-spend...

> People are unwilling to hear this: This was a problem well before the pandemic

This is likely the biggest problem we face right now. People don't care or don't want to hear anything "negative". We call it toxic positivity.

>toxic positivity

I dont know how big of a driver this is tbh. It seems more that a lot of people committed (publicly) to opinions and are unwilling to even consider to have incomplete, or even wrong views. While in practice the overlap to toxic positivity is likely large, i think it misses that the cause is likely emotional/ego driven. So that people arent so much attached to positive narratives but their narratives?

Or what do you think the causes are?

edit: Never mind, should have just googled for toxic positivity. Thanks for the term!

Wrong. This has nothing to do with NHS because a similar surge of mortality has been seen in other countries. Surprising the BBC journaliste didn't think of checking this out.

Example with France: https://www.leparisien.fr/societe/mortalite-autant-voire-plu...

It's a bit late, though, to complain about a consequence of lockdown now.

Do you have peer reviewed evidence that lockdown is responsible for the excess deaths and not - for example - a deadly virus that happens to have been ripping through the population?

> Do you have peer reviewed evidence that lockdown is responsible for the excess deaths and not - for example - a deadly virus that happens to have been ripping through the population?

The article literally talks about this, and it doesn't seem directly related to COVID. Part of it is no doubt delayed diagnoses which led to terminal cases, inability to get care for mental health, and overtaxed and underfunded health systems.

I don't need a "peer-review scientific study" or "50year-long statistical study on 10,000 people", and then a peer-review to review the peer-review, to know that if you can't go to hospitals for 2 years, you'll be more ill as a result.

there is a health crisis in France too with underfunded and understaffed public hospitals (lots of healthcare workers resigned after covid)

120k is "meaningless" if you do not mention how large of a population and how long of a duration - and the comparison that you do use is basically "clickbait".

And if you do not compare it with other causes of death, someone that doesn't deal routinely with these numbers (so, most people) still has no idea how much of a problem it is. (For instance I've been comparing war deaths in Ukraine to roadkills in Ukraine to gauge this.)

In percentages it's an excess mortality of approximately 7%.

As in "7% of people who died, have died in excess of what we expect".

It should be noted that in the years prior to this, excess deaths were falling precipitously. (10-20%)

Eitherway, it's well documented in the studies.

https://www.youtube.com/watch?v=owI7DOeO_yg

Lots of people voted for it. They believe they are good people. Of course they won’t believe facts that challenge that.

> 120,000 is a large number. It's approximately half of the entire city of Aarhus (Denmarks second largest city).

That's a terrible comparison though. In the US, about 3.3m people die each year. That's almost 60% of the total population of Denmark. A Denmark dies in the US every 18 months.

But that's just what you get when you compare a city with the population of a country that is a hundred times its size.

It's hard to actually visualise large numbers; a common problem actually

Tom Scott has a great video on it: https://www.youtube.com/watch?v=8YUWDrLazCg

EDIT: Decide to swap the examples to British cities, inkeeping with what you said about apples/oranges; which people may be less familiar with; but hopefully it gives the sense of scale.

Sorry, I didn't mean the comparison to be a problem because Brits aren't familiar with Aarhus, but because I doubt the usefulness of this type of comparison.

"It's a large number" isn't useful when it's a percentage of an even larger number. ~1% of people die each year. Larger cities or nations will obviously have higher absolute numbers -- but what does that tell us besides that more people live there? If you can't visualize 120,000, can you visualize 67,000,000? Would "We'd losing a population the size of Aarhus if our population was the size of 100 Aarhuses" really make things clearer than saying "about 1% of the population dies in any given year"?

How would you communicate such figures.

There are a total number of people who have died who wouldn't have otherwise.

It's not about "what is the delta" it's about imagining a literal city full of people who have died prematurely.

In terms of absolute numbers, "7%" is high, but not enough to really evoke any emotion in the reader.

How would you prefer to convey emotion to the fact that people's family members are no longer with us because of an economic policy which doesn't actually save the country money and has more in common with religion than economic science.

> It's not about "what is the delta" it's about imagining a literal city full of people who have died prematurely.

That's the thing though, there's always a city full of people who die, and it's pretty much always prematurely if you ask anyone that cared about them. There's no reason to help people visualize the actual number because the actual number is irrelevant. Would a 7% increase in the death rate be less shocking in Denmark even though it'd just be five villages and not half a city in absolute numbers?

Looking at absolute numbers to visualize things that are relative confuses people, because you'll need to play weird games when you want to get your point across but your population is 5m. "If we had 50m citizens, this would be half a city" is weird, people will rightfully say "but we don't, what are you talking about?"

I don't believe news should be aiming to convey emotion, or be manipulating. I also don't believe that the "how many football fields is that?" approach to news is useful.

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