The end of the NHS - Privatisation

[Traduk]

Originally Posted by Ignitionnet

Traduk,

No idea of your age, and unsure of the relevance of my age, I'm more than old enough and have more than enough life experience to have lost the egocentrism of youth but perhaps you'd care to re-read my post? I'll quote the relevant bits and highlight them for you.



Not caring about the NHS and not caring about public healthcare are not synonymous. Quite frankly they are quite the opposite now, clinging on to the NHS like some long lost friend is precisely what will hold healthcare back.

Twice your age + 1.

What you fail to take into account is that this country is based on elements within society being totally free at point of delivery. We do not have the structure which allows for co-pay or full pay for the services that are inherent within the system and have been since the initiation of the welfare state.

Your views generally are very right wing but as a generality talent is not rewarded in a manner that facilitates pay as you go. An example would be a surgeon on about the money you appear to earn who has left these shores for foreign parts for 2.5X UK salary. Even at highish tax rates he can co-pay for whatever is needed albeit it takes a move half way round the world to change the economic scenery.

I have used private dentistry for decades and without doubt I get the best that money can buy but it costs thousands for almost anything restorative. My choice forced by an absence of NHS facilities or even if available restricted to the bear minimum for oral health. That part of the NHS is already co-pay and beyond the basics of drill it, fill it or pull it, it costs. It is a basic and IMO poor service. It is one that I wouldn't want to see medicine follow but suspect that it will.

I latched on to your post because there was an element of "I'm alright Jack" within it as there is with a lot of your posts. What you fail to recognise over and over is that somebody has to pay and trying to ameliorate your suggestions with wishing for the best treatment at the lowest cost cannot mathematically square with any change to what exists currently on a cost basis.

Your comments which you kindly highlighted for me advocate co-pay. The government is pursuing policies in other areas (universities) on where co-pay goes. It starts low to get the ideology accepted and then to save costs on the public purse the burden falls more heavily on the user. That is in action at this time.

If the same principle gets into health everybody's future looks dire because invariably the time of greatest expense on and for an individual is when they are least able to afford it. My reference to your age is not personal but at your age insurances whether life or health are relatively low cost. As with both of those types of insurance as years progress and they become most needed they are priced according to risk and are prohibitively expensive, even for people with substantial financial backing.

I read your posts and frequently see a lack of differentiation from where this country has been to where it appears to be going. Private pensions have always been historically linked to state provision with supplementation taking place one to the other. With the movement of retirement age that model is now bent moving on towards broken. Total self provision will not occur with historic co-pay (employer\employee) relationships. Both need to be doubled with pot\s being filled at around 33% of salary per annum over a working lifetime.

In retirement it is necessary to be fairly wealthy in untouchable money in order not to be poor. Heaven help us if this lot throws medical costs into the equation.

[Ignitionnet]

Originally Posted by Traduk

Twice your age + 1.

What you fail to take into account is that this country is based on elements within society being totally free at point of delivery. We do not have the structure which allows for co-pay or full pay for the services that are inherent within the system and have been since the initiation of the welfare state.

I entirely take it into account and disregard it. It doesn't work anymore and needs to be disregarded. When it comes to my and my family's future I couldn't care less what the country is built on, I care where it is going I couldn't give a jot for nostalgia I want whatever works and offers the best prospects.

Originally Posted by Traduk

Your views generally are very right wing but as a generality talent is not rewarded in a manner that facilitates pay as you go. An example would be a surgeon on about the money you appear to earn who has left these shores for foreign parts for 2.5X UK salary. Even at highish tax rates he can co-pay for whatever is needed albeit it takes a move half way round the world to change the economic scenery.

I am somewhat disconcerted that my views are apparently 'very right wing'. I entirely disagree that they are 'very right wing', I am considerably to the left of the right wing in the United States for example. If I am 'very right wing' it shows how far to the left this country has swung, and we can all see how well that's worked out for us.

Originally Posted by Traduk

I have used private dentistry for decades and without doubt I get the best that money can buy but it costs thousands for almost anything restorative. My choice forced by an absence of NHS facilities or even if available restricted to the bear minimum for oral health. That part of the NHS is already co-pay and beyond the basics of drill it, fill it or pull it, it costs. It is a basic and IMO poor service. It is one that I wouldn't want to see medicine follow but suspect that it will.

I disagree that there will be an inevitable co-pay element to medical care. I would however have no problem at all with there being a co-pay element for those who are capable of paying, on condition that there is an element of give in return, my specific thoughts being a tax incentive for having private healthcare rather than the current system of regarding it as a taxable benefit if provided by an employer.

Originally Posted by Traduk

I latched on to your post because there was an element of "I'm alright Jack" within it as there is with a lot of your posts. What you fail to recognise over and over is that somebody has to pay and trying to ameliorate your suggestions with wishing for the best treatment at the lowest cost cannot mathematically square with any change to what exists currently on a cost basis.

I would draw your attention to what I specifically said:

I only care about people getting the health care they need, when they need it, at a price be it via taxation, insurance or a combination of both which is as low as possible, to the highest feasible quality.

Caveats 'as possible' and 'highest feasible'. It will always be a balancing act, I'm not naive enough to think good medical care is cheap.

Originally Posted by Traduk

Your comments which you kindly highlighted for me advocate co-pay. The government is pursuing policies in other areas (universities) on where co-pay goes. It starts low to get the ideology accepted and then to save costs on the public purse the burden falls more heavily on the user. That is in action at this time.

What is wrong with the costs of using a service being in part borne by the user? Even super socialist France operates co-pay, I don't see riots over it there?

Originally Posted by Traduk

If the same principle gets into health everybody's future looks dire because invariably the time of greatest expense on and for an individual is when they are least able to afford it. My reference to your age is not personal but at your age insurances whether life or health are relatively low cost. As with both of those types of insurance as years progress and they become most needed they are priced according to risk and are prohibitively expensive, even for people with substantial financial backing.

I'm not advocating mandatory private insurance. Single payer insurance where risk is entirely socialised across all age groups needn't be inordinately expensive for the more elderly within society and, of course, I would hope no-one expects those who have reached the state retirement age to pay.

I draw your attention to this:

I couldn't even care less about it being completely free at the point of delivery, many other systems with much better patient outcomes employ selective co-pay.

I apologise if I was not clear but by 'selective' I was referring to selecting subsets who are capable of paying rather than expecting those on the bread line, those who have retired and those who are unemployed to pay.

Originally Posted by Traduk

I read your posts and frequently see a lack of differentiation from where this country has been to where it appears to be going.

I do not understand that statement. If it means what I think it means that is because I couldn't care less where this country has been as far as social services and health care go beyond avoiding the mistakes of the past and care only about where it is going.

Originally Posted by Traduk

Private pensions have always been historically linked to state provision with supplementation taking place one to the other. With the movement of retirement age that model is now bent moving on towards broken. Total self provision will not occur with historic co-pay (employer\employee) relationships. Both need to be doubled with pot\s being filled at around 33% of salary per annum over a working lifetime.

I cannot say this makes much more sense. Increasing the retirement age is absolutely required to offset increased life expectancy and ensure that schemes remain viable.

Originally Posted by Traduk

In retirement it is necessary to be fairly wealthy in untouchable money in order not to be poor. Heaven help us if this lot throws medical costs into the equation.

No-one apart from those who are genuinely on the right wing in a big way would even contemplate making retirees pay for health care. Even in the United States Medicare is present to look after them.

[TheDaddy]

Originally Posted by Ignitionnet

Even in the United States Medicare is present to look after them.

Only if said retiree is ill for less than 100 days...

The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2011, $141.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell.

If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period.

http://en.wikipedia.org/wiki/Medicare_(United_States

A work mates father in law is due to be kicked out of a nursing home any day...

[Ignitionnet]

Just as well I wouldn't, for one moment, advocate moving to the US system.

[Traduk]

Ignitionnet,

I have read through all your points and can see that we have the much to be expected totally different perceptions of the way forward. We are and will remain on opposing sides of the generational battles which were always going to rage between the Boomers generation and the cohorts coming through. I have forgotten the generational archetypes names but if I recall correctly your lot was never destined to be a good one.

Had the coalition reigned in the exuberance of Cameron and co. they might have started to move the country towards the end objective of self reliance but too fast too soon will be their downfall.

The changes planned for the NHS have the potential to be devastating with potentially entire hospitals operating at the mercy of GP groups. Thousands controlled by dozens never works especially with the private sector looking for tasty pickings. What will stop the unwanted progress.... The remaining bastions of union power lie within the nerve centres of every part of government and strongly within the NHS. The TUC turnout was a pointer of what is to come because if fear can get so many up to London wait to see what real pain does.

If you had lived through the 70's\80's you would see the writing on the walls. This debacle (recession) is shaping up to be potentially much worse than back then but thanks to the too fast too soon coalition the heat under the pressure cooker is turned up high already. After the May 5 elections with the Liberals possibly reeling from a mauling, expect the beginnings of the noises that lead to action.

This lot do not have a hope of going full term nor I expect will the lot who follow them. I think that we will go through years of musical chairs in Westminster until somebody emerges with problem solving skills rather than an ideological agenda. Even Thatcher at her most powerful over stepped the mark but this lot have gone where no other politician dared to tread right from the get go. They have no chance.

If I was your age and without older family commitments I would be seriously looking to bid farewell to my country of birth. Sadly I cannot see a way forward so unless someone with vision and the ability to sell back to the owners what they already own like Thatcher did I would say that we are stuck between a rock and a hard place ad infinitum. As you point out frequently we have not lived within our means for decades but when you look hard at what that truly means it doesn't give much of a life to anybody.

[Ignitionnet]

I don't actually have any comment to make on that post. While we disagree on many points, and many specifics which we could talk back and forth over for a while, we fundamentally have the exact same concerns longer term so I'll leave your eloquent, articulate and sincere post undiscussed and thank you for a very pleasant and informative discussion.

EDIT: Post 7,777 and it was a polite one, cool.

[Traduk]

Originally Posted by Ignitionnet

I don't actually have any comment to make on that post. While we disagree on many points, and many specifics which we could talk back and forth over for a while, we fundamentally have the exact same concerns longer term so I'll leave your eloquent, articulate and sincere post undiscussed and thank you for a very pleasant and informative discussion.

EDIT: Post 7,777 and it was a polite one, cool.

Thank you.

You are correct about us both having similar basic concerns but with a variation on application and timing. Fortunately for both of us there is an element of quantum theory in life where from a wrong place, eventually self organising chaos finds the correct path.

We could type on indefinitely but the same ground would just be covered in different ways. It is hard to formulate an argument against change when I know it is needed but with a preference for slower phased rate of change.

I like thought provoking discussion with a nice bit of lateral projection. I think my tendency to be too blunt came through and I might have been too personal. Apologies for that and thanks.

[Chrysalis]

in all honesty giving GP's control scares the hell out of me.

I have already seen the affect on GP's been run privately.

Examples.

0845 number to ring them up.
Extremely hard to get home visits, almost impossible in fact.
Massive variation of GP quality between different GP's my parents GP has no problem doing phone consultation, mine refuses to do it.
Some GP's dont even have permenant GP staff, they just always use temps as cheaper.
A reluctance to reffer people as it costs money.
Are we going to see GP's refuse to take patients (previously the nhs trust forced them to). So end up like the dentist situation where millions of people dont have a dentist.
Finally the tendancy to make patients see a nurse or someone else who isnt a fully trained doctor instead of a GP as not enough GP's to see all patients.

Also what parts of the NHS do people consider overstaffed? and how have they came to that conclusion. for what its worth I do feel the NHS has excessive nurses but a severe shortage of doctors.

Everytime the tories are in power they privatise something and then a few people get very rich out of it.

Ultimately once something is privatised freedom of information act requests cant be done either and they can hide behind commercial confidentiality.

My thoughts are and always will be that anything that affects someones welfare should not be run for profit or privatised.

---------- Post added at 05:36 ---------- Previous post was at 05:14 ----------

Originally Posted by slowcoach

Privatisation is the answer.

Water, Gas, Electricity, Buses and Trains prove the point, all are relatively much cheaper for the consumer now.

---takes off my blinkers and climbs back into my straight jacket.

you lost me, gas is certianly not much cheaper it is much more expensive.

However people have the wrong atittude if they think cost is king for healthcare, which would you prefer.

a 85% efficient helathcare system that can succesfully treat 10million people year.
or a 60% efficient more expensive healthcare system that can treat 12 million a year.

to me its the latter very time and how do you decide if its efficient?

Some of the things labour did for the nhs are good like the waiting list times and nhs trusts, where they went wrong was giving out huge wage increases without real justification which ended up chewing up significant parts of the extra funding as well as giving away too much to GP's who incidently now do less patient care for more money.

[the_neurotic_cat]

I just can't see how healthcare could ever be profitable. There's a bottomless pit of demand for healthcare services, which is why we have waiting lists. If there's 'profit' being made then that, by definition means that someone somewhere went without treatment or insufficient treatment.

Profit and Healthcare are just incompatible. I'd rather have spending accountable to the ballot box than some distant anonymous bank manager.

Originally Posted by the_neurotic_cat

I just can't see how healthcare could ever be profitable. There's a bottomless pit of demand for healthcare services, which is why we have waiting lists. If there's 'profit' being made then that, by definition means that someone somewhere went without treatment or insufficient treatment.

Profit and Healthcare are just incompatible. I'd rather have spending accountable to the ballot box than some distant anonymous bank manager.

Actually i think the opposite is true.Healthcare is a money spinner ,from the drug companies ,insurance companies,suppliers of machinery,everything a hospital needs to operate is a cashcow for those involved .A private hospital will always make a healthy profit ,it's the NHS hospitals that lose out because they operate within a tight budget whilst having to cope with price rises from their suppliers

[Ignitionnet]

Originally Posted by the_neurotic_cat

Profit and Healthcare are just incompatible. I'd rather have spending accountable to the ballot box than some distant anonymous bank manager.

I'd rather have spending accountable to those who are paying, and an independent non-political body such as, hmm, an Office of Budgetary Responsibility say, to ensure that unrealistic amounts aren't being spend as bribes at the ballot box to the detriment of both public finances and efficiency of healthcare provision.

Not that this ever happens of course

I disagree that profit and healthcare are completely incompatible. At the front line I would agree that it's a precarious relationship and healthcare will never be super profitable however profit and quality are not always on opposite ends of the spectrum.

Certainly there is profit to be made from support services. Doing things well reduces their cost to provide, splitting the difference on that saving between the health service and the provider of support means government saves and profit is made.

The ideal is, of course, that the NHS can handle everything itself as well or better than if it were reduced in size via segmentation or private companies involved. This is also not the case, the bigger the NHS gets in terms of staff and spending the less and less value it provides for that money.

Originally Posted by the_neurotic_cat

If there's 'profit' being made then that, by definition means that someone somewhere went without treatment or insufficient treatment.

If a state-controlled system can treat 6 out of 10 terminal cancer patients for a given amount of money, and a private system can treat 9 out of 10, with the same money, but then also financially reward the people who made that efficiency possible, under which system are more people going without treatment?

[Chrysalis]

Originally Posted by the_neurotic_cat

I just can't see how healthcare could ever be profitable. There's a bottomless pit of demand for healthcare services, which is why we have waiting lists. If there's 'profit' being made then that, by definition means that someone somewhere went without treatment or insufficient treatment.

Profit and Healthcare are just incompatible. I'd rather have spending accountable to the ballot box than some distant anonymous bank manager.

it can be profitable quite easy. examples.

1 - pay a company you own for supplies or services and deliberatly overpay.
2 - reduce quality of service, eg. 12 hour waiting in a&e by cutting staff, stop prescribing drugs to people who get free prescriptions, drop refferal rates, sell of equipment, rent out parts of hospitals for premium use.

You forgot one:

3 - Look after resources more carefully, understanding that your ability to make a living is directly tied to your ability to work efficiently.

The public sector is wasteful because it knows there's nobody else to do the job It doesn't have to raise its game, and it knows it. Simples.

[Ignitionnet]

Originally Posted by Chrysalis

it can be profitable quite easy. examples.

1 - pay a company you own for supplies or services and deliberatly overpay.
2 - reduce quality of service, eg. 12 hour waiting in a&e by cutting staff, stop prescribing drugs to people who get free prescriptions, drop refferal rates, sell of equipment, rent out parts of hospitals for premium use.

Well given NHS efficiency and value for money has dropped by 13% in the past 10 years simply restoring that not particularly spectacular level of efficiency would allow for 8% more productive use of money and 5% profit for the provider for example.