wow. What ground in America, Britain and France "keep" after the war. They didn't claim: Poland, Bulgaria, Romania, Czechoslovakia and eastern Germany for any "buffer" from any future invasion. Draw a straight line from any point 1,000 miles long from the "iron curtain" and you will find you have covered the entire European continent. Uncle Joe would be proud of this argument. Everyone would love to have a 1,000 mile safe-zone from future invaders. Unfortunately, there's a lot of people and sovereign nations in that space.
The dismantling of the NHS and further movement towards free-market healthcare isn't something I'm particularly resentful of. There are some positives that could come out of this. Let me first tackle the argument that free-enterprise heatlhcare is biased to the rich, and ignores the fact that the poor and lower-middle class will struggle to afford it. Well there's a couple counter points to that. For one, if this was to happen it could go a long way towards abolishing income tax completely and drastically reducing the VAT sales tax. This would mean everyone including even the poorest could find it more financially viable than paying 10% personal income tax and 20% VAT sales tax like they currently do in order to help fund an inefficiently run public option. A quick google search on how much health insurance costs here in the UK tells me it ranges from £10/month for the basic necessities to £150/month for comprehensive coverage (all depending on how you tailor it to your specific needs). Also, as long as the state covers the costs for children, those unable to work such as cancer patients and with most types of a disability, then I see no reason why from a financial perspective it has to be a problem. Everyone else would be better able to take on the burden of the cost for themselves with a job or their pension. There is also a moral case for completely free-market provided healthcare. Because there would be more competition as a result of hospitals, GPs, and dental practices, etc. being run by free-enterprise, there would naturally be an improvement in standards and healthcare costs could quite likely be driven down. Also, because we would be paying for the healthcare service directly this could also mean better quality care for the patient as we would be the customer of these services, and business always needs happy customers in order to prosper. For example when my grandma was at an NHS ward for three months before she passed away at the very same hospital, she was always unhappy with a few of the nurses (and she's not even the type of person to complain). Whenever we did go to make a complaint on her behalf we were always left with the impression that they were more or less disinterested and saw us as an annoyance. I feel like if we were their customers they may have been more inclined to take action and to keep my grandma happy. I used to be one of the biggest proponents of the NHS, but since listening to both sides of the argument - in favour and against privatised healthcare - I just started to approve it more, and this was even before the situation with my grandma and the NHS.
You don't need the Andrew Lansley reforms to be customers - you are already. Your commissioner (PCTs currently) pays whichever provider you choose to go to for your treatment. The only difference that the reforms will bring in this respect is that whereas you've got 151 PCTs (in England) you'll have upwards of 400 GP Consortia that hold the cash and dole it out to whichever provider treats you.
But it's still not the same as the patient physically handing out the cash or insurance details themselves before they leave the clinic/hospital. I was merely trying to address Nexxo's theory that if in ten years time there was no NHS at all and it was all free enterprise, not these Lansley reforms. That's what I was trying to argue for, these current reforms still aren't all that different to the current system because it still involves a lot of government intervention, but I can see how they could pave the way for a fully free enterprise market. And I think it's worth highlighting that Andrew Lansley MP is hardly iconic of free-market economics when you read things like this about him being secretly lobbied by private health providers.
Ok, spec finally gets involved. It could, but it wouldn't. If you take a long enough view of things, taxation doesn't go down. The government could easily get rid of plenty of taxation, but then the government is essentially an organisation that exists to spend the money they extort from us by violence. They will not reduce that money in any significant way. An inefficiently run public option is preferable to an inefficiently run private option. Given that one has the overhead of profit and the other doesn't. The US health industry, which composes the primary group of companies just dying to get their hands upon our £100 billion or so health budget appears to be pretty damn inefficient, given that the US spends twice as much on it's healthcare as we do, for a system which is ranked more than twice as low as us. That's not even taking into account the economies of scale which should most certainly apply when you consider the US is providing healthcare for around 300 million people and the UK is providing it for only 62 million or so. That's why the idea of different levels of insurance are a bit of a sick joke though isn't it? No-one knows they're going to have specific needs until those needs arise - at which point the insurance companies will tell you to take a hike if you desire to suddenly upgrade your insurance from that £10 a month stuff to that £150 a month stuff, because your £10 a month stuff doesn't include that £300,000 operation which would save your life. I see no justification nor reason for the idea that if the state were not running a monopoly with significant economies of scale that smaller private organisations which require a profit would enable people to better take on the burden of the cost. That's a capitalist arguement that, despite me being economically extremely right wing, I think is a pile of horse manure. Why would we "naturally" see this improvement in standards? Because of competition? Right, for a time. Competition forces a company to improve its standards, at the result of lower profits and higher levels of service. So in a free market any company will naturally follow the short term goal of even lower profits still, in order to obliterate the competition, at which point it provides whatever service it can get away with for the highest price it can. My home city had the same old random cinema it'd had my entire life untill I was 16. Then VUE moved in, which was great. Tickets were half the price of the other place, the screens were way bigger, and popcorn was the same price. Eventually the old place went out of business. Shortly afterward, tickets were about 20% more than the old places tickets had been, popcorn had gone from £1.50 to £5.50 a bucket, and the cleaning standards and general niceness of the place went to hell. It's a standard strategy: big company moves in, runs at a loss untill small company dies, then makes massive profit because they're the only option consumers have. The NHS is the old cinema, private healthcare is VUE. Capiche? But you wouldn't choose, your insurance company would choose. Your choice is in picking the insurance company, but if they're all morally corrupt invertebrate scumshits like insurance companies in the US, then you're pretty much screwed, aren't you? Need I remind you who the companies that are dying to provide the UK with private healthcare services are? My grandma too was unhappy with NHS treatment, a black doctor gave her an injection and her arm swelled up a bit, and she thought a "darky" was trying to poison her. Not to say your grandmother didn't have a legitimate complaint, there's bound to be bad apples in the fourth largest employer in the world, but that doesn't mean the whole thing sucks, and it doesn't mean every complaint people have about the NHS is legit. Here's what's going to happen if free market capitalism is allowed into our healthcare systems. Pick a region, any region. Now in this specific region, a healthcare company will move in. They'll have maybe 5-10 hospitals, plenty of financial backing, and they'll hire very good doctors who provide a great service with near no waiting times and everyone who goes there will be happy. This will lead most people to go there. That's great. Even if these private hospitals in this region we've picked don't do well immediately, that's fine, because they've got a billion dollar industry behind them over the pond picking up the tab. Meanwhile, NHS hospitals are on their own. They get paid for what they do, and if they don't perform above the standard of private hospitals every single year, forever, they will lose a lot of that funding. If an NHS hospital is deemed to be performing badly for 5 or 10 years, it will be shut, instead of being improved with high doses of foreign investment. Eventually, every NHS hospital in this region we've picked will perform less well than a private hospital, for enough time that the private hospitals take over the region. Patients will be happy, government will be happy, even Doctors who're being paid much more money will be happy. Then this will spread, it will happen in the next region, and the next. Before long, in that first region we talked about, standards will fall. The small number of private healthcare companies will realise that if they all lower standards to the minimum allowed, and screw over patients to the maximum allowable level, they can make a lot more profit and do a lot less work (See: USA). Standards will go down, Doctor pay will go down, the government will be unhappy but basically unable to do much because there's no way it will have the money to rebuild the NHS. What will we be left with? An even more expensive, profit making healthcare system which will ultimately, if it follows the usual practices it follows in other countries, provide the lowest service standard possible for the highest price. This will be funded from our tax money, and we will be unable to reverse this change, if it happens. That's what the Tories are saying, but they're either being uttery disingenuous or completely retarded. I suspect both. Frankly, my opinion of this government is very low right now. As someone who cares about defence of the realm and the armed forces, and as someone who pays tax, I think the fact that they're just this week chopping up about £4.5 billion worth of Nimrod is criminal vandalism against what is 1/62,000,000 my stuff (that's £72 mine, in other words). Destroying stuff like Nimrod is bad, sacrificing national security because they're too poor at even being Tories to value national defence as the number one role of government is piss poor, but if they destroy my NHS, your NHS, and everyone elses NHS because they're too ****ing stupid to see what their free market competition reforms are going to do to the thing, I will dance on their graves when some poor terminal cancer patient takes them all out.
If you definitely are being sarcastic then I can see what you're implying here, but you're wrong about whatever idea you got about me from my post. But ignoring that for a second, I wasn't saying the whole NHS sucks because of it, but just pointing out the fact that as a general rule customer service at a business is better than at a public institution. Aside from that complaint issue we were quite happy with her care. Capiche Whatever way the NHS decides to contract its work, I think our healthcare market should stay the same as it is: that is 90% of population use NHS commissioned/owned hospitals/clinics, and the top 10% richest carry on using private which helps take the pressure off the NHS.
Just how good customer service in business is can be gleaned from the ombudsman and consumer rights programmes. Heck, just do a search on these forums to find our what people think of the customer service of various ISPs, mobile phone companies and mail order businesses. I'm not sure you do Capiche. Two aspects that Spec's most excellent post did not get around to touching on was cherry picking and moral hazard. Not all health care interventions are profitable. Some are relatively easy and cheap to deliver and make a profit. Some are hideously complex and expensive (they also tend to be the life-saving ones) and run at an eye-watering loss. But they need to be done. In the NHS their cost is subsidised by the profit-making interventions. Now when a nice, shiney new private health care business sets up, which interventions do you think they will choose to provide? The easy, low-risk profit-making ones? Or the complex, high-risk loss-making ones? Which, therefore, will the NHS be left with? That's right, the complex risky loss-makers, because they still need to be done. You know, all the unglamourous crappy stuff that ordinary people cannot afford and no health insurance will touch with a barge pole, like bone marrow transplants, long-term elderly dementia care, stuff like that. And because that stuff still needs to be delivered, and the NHS has lost its profit-making services, guess who ends up funding these services? Yup, the tax payer. So now we have two health care expenditures: a private insurance to pay for privately provided health care services, and a NI to pay for the unattractive but necessary services that the NHS stays lumbered with. The second issue is moral hazard: those who are most prepared to pay out a hefty private health insurance fee are the ones who consider themselves most likely to claim: the disabled, the chronically ill, those on high-risk jobs. The young, poor and healthy won't, because they can't afford it and they have more immediately pressing expenses such as student loans and trying to get on the property ladder (they are the ones that get unstuck when against all expectation they get hit by a truck and need lenghty brain injury rehab, or they develop Acute Myeloid Leukemia out of the blue). Of course, the more people pay the more they are likely to claim, because they want their money's worth. So health insurance fees have to go up to still make a profit. More people drop out of the race and the only customers left are the really rich and really sick ones. Rinse, repeat... The result is a two-tier health care system: a shiny private one for the privilliged, finely tuned to milk your insurance of every drop so that even a moderate illness becomes a costly experience that raises your renewal fee to unaffordable levels or even makes it impossible to renew your policy at all (most companies won't insure me, for instance, just because I have genetic hypercholesterolemia, even though my cholesterol levels are bang-on 5.0, my blood pressure is normal and I don't smoke), which means that even when you are seriously ill andadequately covered you are too afraid to claim. Which means that eventually, whether you claim or not, you end up in: Tier two: a tax-funded, bare necessity NHS which is even more inundated by complex, resource-sapping cases such as the long-term mentally ill, the disabled, the chronically sick and elderly poor. If you thought your grandmother had a bad time, imagine where she would have ended up in that system. Imagine the disinterest from private companies who are in the business of actually making money, and who know they have you over a barrel. Imagine your gran's health insurance refusing to pay up because her package contained legalese small print that she could not read and did not understand at the time, that says that old-age conditions are not covered, never mind that she was 65 when they got her to sign on the dotted line. You have not thought this one through. Few people have. They have not had to, because the NHS means free health care for all at the point of need, irrespective of illness, social class or income. You don't have to be an informed consumer doing a lot of research into your health care purchasing decisions (which is always a bit difficult when you are rolling on the floor with a burst appendix, or are just being cut out of your car wreck) because you know that wherever the ambulance takes you, you are going to get decent health care (not wonderfully great, perhaps, but decent) and you will never have to worry a second about a mounting hospital bill. The NHS is God, IMO. It is the one thing I passionately believe in, the one shining light of human civilisation in a ****ed-up, nasty and barbaric world. You really don't know how much you live in paradise.
OK thanks, that was enlightening. I suppose the best thing for the NHS as a public service would be if it was fully publicly owned. And I agree there is something very admirable about the NHS in the way there is absolutely no discrimination.
I try not to bang the "Nexxo always speaks the truth" drum too often around here, but that was a truly enlightening post. I finally get things, more or less. At least the downsides of privatization. Are there upsides to it worth mentioning?
It is true that the NHS is a bit bureaucratic, inefficient and inflexible, but so is Microsoft, or any big complex business. Although it could adopt a few commercial business strategies, it should not adopt the philosophy. In the end it puts a price on human life, and one that not everyone can afford. We see how countries fare that have only private health care: India for instance, or African countries. We see how the US is working out despite Medicaid and Medicare. By comparison we have countries with public health care: Cuba, which outperforms any South American country and even the US, and there is the UK, Scandinavia and Western Europe. All fare better than countries with only private health care systems.
If you want to get philosophical about it, it comes down to one thing... universal health care is a matter of public safety and interest the same way the fire brigade, police, and judicial system is. Except for one nagging thing that makes me doubt this. Your diet so that you can go on living every day and clothing and a home so you can keep warm at night is also just as important as your health care. You need those things for a healthy life style just as much as a doctor for when you're in need. So why don't we have universal provision of these things? What I'm saying is, where do we draw the line?
And in a more extreme example, why legalize tobacco and alcohol when they place such a huge, unnecessary draw on the NHS - and, more importantly, violate the principle you've pointed to, public safety and interest? Hypothetically they cover their own costs, so to speak, by having extra taxes on them that take care of the extra burdens on the NHS, but in principle it's still troubling. I've been raising this example a lot in recent applied ethics discussions. We legally enforce seatbelts, denying them the freedom to risk destroying themselves; why allow them to use statistically more certain means like drugs? Even more essentially than that, the core question is: should we save people who don't specifically want saving or seek help? A neat solution would be optional national healthcare: you choose whether to pay the taxes, which are nominal, as currently, and if you don't, you don't get the healthcare. Like privatization, but not privatized. I often wonder why more taxation systems don't work this way, the way f.ex. TV licensing works. Pay if you want it, but leave it under government control.
We do have a universal provision. It's called social welfare. boiled_elephant asked what the upsides of privatisation are. In principle, a free market economy provides incentive for an optimal match between business and consumer: business tailors its services to what consumers want, and consumers pay what they think the service is worth. Win-win. Except that there are a bunch of assumptions in a free market economy neatly hidden in the word "free". The first is that the consumer is free to buy a service, free to go to a competitor instead, or free to walk away altogether. Spec has already shown how a sufficiently well-resourced business can get rid of the competition. But even then, you can choose not to pay the exorbitant ticket or popcorn prices and just stay at home, watch a DVD and enjoy your crisps. However health care is not something you can necessarily do without, or administer yourself through home remedies. Once a private health care company is the only game in town, it has a captive market. There is also the assumption of symmetry of information: the consumer knows what the business knows and can make a valid and informed decision. But we all know it don't work like that in commercial business. Business can be economical with the truth, distort it in ways that favour them and psychologically play on our purchasing decision processes in all sorts of clever ways. And although most consumers can pick a halfway decent TV off the shelf, they already struggle to find the best mobile phone deals, the best utility deals, the best car... because the choices and decision factors get complex. Now keep in mind that the majority of the population has a reading age of 8, and 60% cannot point out where their stomach is. Are they able to make informed decisions about, say, cancer treatment? But all that may be academic anyway, because as spec already pointed out, you are not a free consumer. you don't make the purchasing decisions; your health insurance company does. And it is not motivated to find the best health outcome for you, but the cheapest deal for itself. So what you get is not the best comprehensive health care, but the cheapest and most limited that the insurance company can get away with. If you become too costly a prospect in the long term, it may even choose to cancel your policy just when you start needing it most. It may even start arguing that based on some small-print legalese technicality it should not have to pay up at all; just what you need when you are coping with the effects of surgery and chemotherapy: a bureaucratic paper fight with your health insurance, with your life literally at stake. The NHS has a legal duty of care. Does a private health care company? Does a health insurance company? Don't expect our retarded politicians to tie up that legal loose end. So private health care providers may be wary of your insurance company's intentions and not lift a finger for you until they see some freestyle dropped on the table. It's what happens in India, Africa, the US. We see what happens with free markets that provide services and products that people really cannot do without. What's the price of oil again? We see what happened to public transport, utilities, Royal Mail, private funding initiatives and food (supermarkets). For services and products that are life necessities and that are too complex for a consumer to easily understand, government regulation is necessary. Otherwise people get screwed over. And people getting screwed over is bad for all of us, even if (for now) we are not the victims. Desperate people commit desperate acts. Deprivation and crime are related. So what? You are just the guy enjoying the bigger screen and superior seats at Vue Cinema for the moment. Wait until the NHS is defunct, and we'll see what BUPA really charges you.
There are two problems with that. One is about equity: should people who smoke, drink and live unhealthy lifestyles still get NHS treatment? It is tempting to say "no", but then you are moving health care professionals into the domain of making judgements about who is deserving of their care. That is not their job and you'd find most of them would refuse to do so, because it violates all sorts of professional and personal ethics. Moreover then you have to start deciding on what criteria you base that judgement. Personal responsibility? Societal productivity? Tricky. What about the 80-year old unproductive person who smoked at a time when the harmful effects were not known; who drank when everybody drank? The second is that the person who needs the service may not be the person who pays. Should the children of neglectful parents be punished for their reluctance to pony up? The more tricky real-life problem is: what do you do with the people who are ill, but not eligible? Frog-march them out of the hospital? Let them die? Not a place I want to go.
Because you not having healthcare may turn you into something that is bad to society. Imagine that you chose not to pay the tax and you have very few savings, you get some sort of contagious disease that spreads via air and is very lethal, but takes a while to incubate and kill you, normally you would go to the NHS and get fixed, right? In this case you will not have access to a health care system and you spread the disease to lots of people, those that are covered become an extra burden on the system and the ones that are not covered spread the disease... rinse and repeat. The same can be said about vaccination... why people choose not to be vaccinated confuses me a lot. A free or cheap Nationalized Healthcare System should be a must in any modern and civilized society! PS: I heard that there were some Euro countries that privatised healthcare and are doing well, do you know anything about this Nexxo?
what I wonder though about the NHS.. let's say your on your death bed and you believe you need something basic like oxygen.. but it goes to a deciding panel right, and they decide whether you need it or not with private insurance they have to pick up the tab up to your deductible, no matter what the doctor thinks if you really want that oxygen.. that's what the main complaint is here in the US I know it sounds silly because if you can't afford private insurance to begin with here.. your under medicare and in the exact same situation on what is and isn't covered.. but that's the argument a lot of people make about having a nhs style healthcare system
