There is no party proposing to "Privatise the NHS" in this country despite people screaming about this for the last 35 years (or more), it doesn't look very privatised to me. Any what matters anyway. 1. That you can get treated in hospital without paying for that treatment? 2. That the doctor is paid for my the goverment? 3. That the governement owns and runs the hospital? 4. That all the cleaning, maintenance and catering are run by NHS employees. Now to my I can see that you will be concerned about 1 but I'm less clear why 2-3 matter so much. Germany isn't exactly full of poor people dying in the streets but as I understand most of the hospitals are privately or independantly owned. The important thing isn't that the goverment employs the nurses, it's that you have one when you need one.
Which just underlines how completely out of touch politicians are and the completely different reality they all live in.
Starbucks is still in UK because they think they can make it work. They closed 44 company operated shops last year (franchised ones are separate). You can find the info here: http://investor.starbucks.com/phoenix.zhtml?c=99518&p=irol-reportsannual And this is their PR piece explaning their position: It's PR of course, so take with a healthy dollop of salt, but it is plausible and worth reading IMO. http://www.starbucks.co.uk/our-commitment Regarding the taxes, I take your point, but it's all a bit moot. It is true that VAT is paid by the buyer, and collected by the business. But that is a technicality. If I sell something for 100 and get 80, did I pay the VAT?, did you? I could have sold it for 100 without it. You could have bought it for 80. Or 90 and we both pocket a bit more. Regardless, the existence of that business generated that tax. Same logic with employees income tax etc. My point is that, in the grand scheme of things, a business generates a lot to government's coffers besides corporation tax. Why are we giving corporation tax brakes to videogame makers then? Why are the Dutch making special tax deals with companies to move their headquarters there? A business is a business. Moral obligations belong to individuals, and should remain there. when you introduce morality to a business you also have to accept that morality is not universal. Maybe, for moral reasons, a business will not serve homosexuals, or employ not employ Catholics, etc etc. Whenever, businesses "acted moral" it's because it made business sense, not because they "are" moral. Consumers can certainly force businesses to act moral by boycotting, but this is the prerogative of the consumer. So don't vote for politicians with vested business interests. Society is regulating itself, by voting and campaigning. It would be great if companies were run with a moral conscience (of course, my set of morals, not someone else's). It would be wonderful if they were run to serve society before their owners. But that is socialist utopia. It has never ever worked, ever. Even state-owned companies struggle to do so. You can of course "force" them through regulation to be moral within a standard socialist system (the socialist kind of morality). Still, these companies would still be amoral, just following regulations...
1. Great. So why is there discussion over a £10/monthly fee for using your GP? Free at the point of access is looking under threat. 2. Most doctors are still employed directly by the NHS. Some are not, and these numbers are increasing. Virgin Care, for example, directly employ staff rather than utilising NHS staff - and they then deliver NHS services. So no, that guarantee is gone. http://www.hsj.co.uk/updated-staff-...eal-goes-through/5043357.article#.U05nevldXpU (an example of the shennanigans). 3. Massive joke. Most hospitals are mortgaged up to the hilt to private companies under the PFI initiative. Sure, they're technically NHS, but only just. 4. Oh dear. No. Again, PFI is to blame, but support/domiciliary services are the most likely service to not be NHS run, but actually a private company contracted by the NHS. The NHS is heading towards being a brand name, with actual provision being provided by an amalgamation of private companies, state run organisations and a whole lot of confusion. It's gathering pace, with more and more contracts being awarded to non-NHS organisations who then muck things up (see Serco, ATOS). The big issue is that most people, like yourself, still think the NHS is intact and working how it always has, but the reality is completely different.
And without employees generating incoming for said company ? I can't think of any business that generates income for the government's coffers without people enabling them to do so.
http://www.bbc.co.uk/news/business-27046286 Also of relevance for the tax debate. It appears naming and shaming high profile companies has an effect sometimes.
1 - Well to be honest for ages I've been hearing GPs wanting some sort of change per vistit to discourage unnecessary visits and ensure that people that actually need to see them get to see somone on time. It's about the whole thing of something that's given away not being probably valued. But in any case I'd imagine you'd have to give free acess to anyone who gets free perscriptions so it mightent be that extrerme 2-3-4 My point is that I don't see what it matters who owns the hospital or pays the nurses, if the treatement is free. The treatement is the objective, not the employment of staff.
The idea behind capitalism is that it is a just and fair exchange of goods and services because both parties are free to deal or not deal, which guarantees that both parties profit more by dealing than they would have by not doing so. Great in principle; does not work in reality. The choice between starvation and exploitation is not really a choice. It is logistically easier to behave ethically than to behave lawfully. Man, I need a life... More likely it's an "everybody is the hero and martyr of their own story" scenario. Rudolf Höss, commandant at Auschwitz concentration camp saw himself as a thoughtful, sensitive guy who loved his children and who was only following orders as a good officer should. People can integrate the most contradictory behaviours and experiences. We're crazy like that. You have the same obligation to society as the people who work in the shop. So do ordinary people. For instance hospices generally rely on 90% public donations. Volunteer carers and workers save the economy millions of pounds. Unsung heroes, all. Perhaps I should have said: ethical. A healthy society is run on ethical principles. Business is part of society. Hence it should adhere to its ethical principles. After all, we expect its citizens to. It would indeed be great if they were run on ethical principles. That does not mean that they serve society before its owners; just that they serve their owners without violating the ethical principles of civilised society. Why would it not work? Millions of people manage to behave ethically and make a decent living for themselves --I don't see why it should create a conflict with business owners' interests. Or are you suggesting that business is inherently unethical?
Yeah. To what, though... About the NHS: there have been a lot of changes since the picture that you paint. A lot of changes. Currently it looks like this. As you can see, it's complicated. The NHS is slowly devolving to a health care purchaser, not provider (currently it's a bit of both). Certain core services like cleaning, catering, logistics, security etc. have already been taken over by private enterprise, and buildings are owned by PFI. Nowadays any company can tender for a commissioning contract, whether NHS, private or charity, and indeed many do. Now what does it matter to you? Several things. 1. The NHS, being a governmental body, has a duty of care. Private companies do not. We saw an interesting example of this with the PIP breast implant scandal, where private companies disavowed responsibility to replace faulty implants (after all, they reasoned, it was the manufacturer that was liable) and the task and cost of that fell back onto the NHS. Where private patients sued through their health insurance, they found that the private clinics and their clinicians quickly disbanded only to reform under a different company name. Can't sue a ghost... 2. Health economics: The US has a six times more expensive health care system than the NHS for comparable health outcomes. Where does all the money go? Why, towards the massive bureaucratic system of health insurance claim handling. In the US, 50% of the cost of a GP consultation is for the associated insurance claim admin. Then there is the moral hazard principle: the older and less healthy you are, the higher the insurance costs because you are more likely to need health care. I have genetic hypercholesterolemia: I cannot get mortgage insurance because of this (and that's the UK!). Now I can absorb that risk (ironically because I'm an NHS employee I have really good sick pay, retirement on ill health and death in service cover), but what if I needed health insurance? Don't think so. What if you have a congenital disorder? And so sorry if that unfortunate bout of cancer made you uninsurable... Hope it doesn't come back. The dirty little secret is that successive governments have commissioned studies to analyse the cost of NHS vs privatised health care, and much to their dismay the NHS is consistently proven to be the cheapest way to provide health care for all. In mainland Europe that problem was solved by creating an obligatory health insurance for everybody, that everybody can opt into at a capped price. Similarly caps are set on the price of health care services. But that is still state intervention; NHS by any other name. 3. Patient choice: buying health care is not like buying a TV. You don't really need the TV (no, seriously), but you need health care. When you are in the back of an ambulance with a burst appendix you are not really in a position to exercise consumer choice. Neither are you when you have cancer and have to navigate a maze of complex treatment options. You just want your local hospital to deliver the best quality health care there is. Think of a family buying a PC at PC World. Then imagine their lives depend on getting the right one. 4. The price of captive markets. Think utility bills. Think the cost of petrol. They keep rising, and we keep paying, because we're kind of dependent on them. We're a captive market. Without an NHS, private health care will work the same way.
1) Do you know many GPs? I know a fair few (plus a whole load of doctors from FY1 up to consultants, across every speciality under the sun), and you'll find it's a tiny (vocal) minority who are in the press about wanting some sort of a charge. The rest don't want any fee, because then the doctor becomes responsible for collecting said fee, which goes against our ethical principles. Free at the point of care should be exactly that - £10/month might well discourage somebody who actually needs healthcare from attending. Doctors, or any healthcare staff, are not the gatekeepers to healthcare, and never ever should be. 2-4) Yes it matters who owns the hospital and pays the staff, because that influences the treatments available, the ethics of the staff involved and the decisions made by the big wigs in terms of funding. Private companies are out to make money, not fund little Jimmy's cancer treatment that might run in to a couple of hundred thousand for which they can't charge that amount. As Nexxo says, private hospitals in the UK already operate like this. They'll happily take £8k off you for a boob job, but if something goes wrong you get turfed to the closest A&E...run by the NHS. Why? Because A&E is massively unprofitable, and always will be. Private companies have zero interest in running them, because they're literally a money sink. A CT scan costs roughly £130 a go, with the scanners running up bills in the thousands every day. MRIs are nearly £800 per shot, and still get a hammering every single day. Even a normal bed in a hospital is £250, with HDU and ITU beds nearing £1000 per day. It's not a system designed for profit, and this is why America struggles with it so much, because they're trying to wring money out of the system, and they achieve it by denying healthcare coverage to anybody who might be actually expensive (and therefore in the most need). Obamacare tries to change this, but we'll see what happens. The systems in Europe are "private", but are basically the NHS with the taxes we pay being labelled as insurance.
And where does the money come from that business use to pay their workforce ? Business rarely make money on their own, people make money for them, and then hand a percentage of what their employes earned for them to the government coffers.
Yup, and talking about 'puters 'n ****, yo. Cei raises another point I forgot: cherry picking. Eventually the taxpayers pick up the tab for covering essential, but unprofitable services that private companies won't. They get all the profits, we get all the debt.
Where I live you don't get to see the doctor, there is 6 doctors that service over 10,000 patients at 3 practice's so they have a system where you first have to get in the queue on the phone and ask for the doctor to phone you back at some time this maybe the same day maybe the next, once you have spoken to the doctor he will diagnose what's wrong and write a prescription that will be sent to the chemist normally the same day the chemist will take around 48 hours to fill and deliver the meds to your home. Only if the doctor feels it necessary will he make you an appointment to see him
You're mistaking the deciding who gets what treatment bit for the actual provision of the bed, the doctor and the rest When we have to use the out-of-hours GP service in Cornwall that is supplied by a SERCO, the service has been fine every time we have needed it for the children. No we don't have to pay up front and they don't ration treatment.
But again you are immediately assuming that a private contractor is given a pile of cash and told "treat what you like and leave what you don't" What I was saying that the funcding and the decisions over available treatements can be made by the NHS, but if you decide soemone needs an operation there is no reason why the NHS needs to employ the doctor and run the hosptial rather than pay for another place to do the operation.
The nice thing about ethics is that you can base your regulations on it, indeed it is what regulations are based on. Actually that is for good laws. Basing your laws in morals is bad, like we do with drugs and prostitution. I can't think of an unethical business activity that is actually legal. Well, there is Tobacco... and payday loans. Oh, and alternative medicine peddlers. In any case, I think they should be regulated and probably will. Like we have done with other unethical businesses, like selling PPI and private parking enforcers. Some businesses do behave ethically without regulation, but not because they are ethical, but for various good business reasons like avoiding burdensome regulations, attract a certain group of consumers, publicity etc. Of course I am sure that somewhere that some small businesses out there are genuinely ethical, they are just not the norm, you can't rely on this and besides they all inevitably go back to amoral business mode as they group and hire a diverse group of people. Think of Google and their "Don't be evil" motto, I am sure they were well meaning.
Because that is how it works. The relatively easy, profitable services are snapped up; nobody is keen to tender for the unprofitable, difficult ones. They still need to be provided however, as the government has a duty of care, so those services need to be heavily subsidised by the tax payer so someone will take them on. Moreover, under the Health and Social Care Act, a healthcare provider must be “licensed” before it can provide NHS care. Monitor has drawn up the licence conditions which are now open to consultation. Within these conditions are “patient eligibility and selection criteria”: This clearly says that private providers can reject patients as long as they reject them according to “selection and eligibility criteria” that they have already published. Remember: private companies have no duty of care. Now of course you'd hope that the commissioners would scrutinise those criteria before offering a contract. You'd hope. But the expertise of the private sector is in winning government contracts. That's how they make a living. They have backrooms full of lawyers who are expert at writing contracts that sound good but hide all the crucial T&C's in legalese.
