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Politics 2023 (Read 465813 times)

TobyD

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#1575 Re: Politics 2020
October 22, 2021, 10:14:43 pm

Isn’t the long term strategy to undermine it to the point that more private sector involvement is the “only” way to fix it?

Just like, say, many of the European healthcare systems that are better than the UK's?

Quite. The problem is that significant NHS reforms won't be popular despite the fact that it is an outdated model which just doesn't work with such a high proportion of elderly people in the population.  Notch it up with other things that are obvious areas for reform,  but political hot potatoes such as drug policy,  the prison system... etc.

TobyD

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#1576 Re: Politics 2020
October 22, 2021, 11:05:05 pm
WFH seems like a reasonable measure: https://inews.co.uk/news/politics/covid-plan-b-working-from-home-is-the-best-way-to-curb-spread-of-virus-sage-scientists-warn-government-1264550

Unfortunately the head of Pret a Manger donates a lot of money to the Conservative party,  so there's bugger all chance it'll happen unless it gets really bad.

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#1577 Re: Politics 2020
October 23, 2021, 11:19:47 am
Isn’t the long term strategy to undermine it to the point that more private sector involvement is the “only” way to fix it?

Just like, say, many of the European healthcare systems that are better than the UK's?

Yes a lot of European systems have some private involvement, but that is not necessarily the reason they are better. I can't comment on whether the NHS needs reform etc, but to go back to the "throwing money at it" angle, to have parity of service with Europe I would expect to have parity of funding. We don't: https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29

Can't link to charts directly but they're easily scrolled down to.

- UK spends much less per person than the EU median, particularly the countries I suspect you are thinking of (Swiss, Norway, Germany).
- UK pays less as a proportion of GDP, and this fell between 2013-2017 whereas it rose in other European countries.
- Proportion of healthcare from public funds actually fairly similar across nations (though UK is high), with differences in how this is collected e.g. differing levels of mandatory state health insurance vs taxation. I think sometimes this insurance based contribution gets mixed up with being "private".



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#1578 Re: Politics 2020
October 23, 2021, 04:51:17 pm
Totally agree with all those points. Mine was simply that people in the UK are bizarrely dedicated to the NHS, and hold it in an esteem it doesn't really deserve. This, combined with the constant comparisons with the US system and how terrible that is, prevents the change that's so clearly needed. Whenever any sort of private funding is mentioned people automatically assume it'll mean going with the US system, and it just doesn't.

TobyD

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#1579 Re: Politics 2020
October 23, 2021, 05:37:35 pm
This, combined with the constant comparisons with the US system and how terrible that is, prevents the change that's so clearly needed.

The US actually has pretty much the most advanced health care in the world, but only if you're relatively wealthy or have a job with healthcare insurance as part of the renumeration. Yes, if you don't have any insurance you get virtually nothing, but if you can afford it it's fantastic.

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#1580 Re: Politics 2020
October 23, 2021, 05:51:40 pm
Toby, I am not so sure about that as rich people in the US have lower life expectancy than poor french people e.g.

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#1581 Re: Politics 2020
October 23, 2021, 05:52:21 pm
Yes, if you don't have any insurance you get virtually nothing, but if you can afford it it's fantastic.

This is like pointing out that some people have nice mansions during a discussion about lack of affordable housing!

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#1582 Re: Politics 2020
October 23, 2021, 07:07:47 pm

This is like pointing out that some people have nice mansions during a discussion about lack of affordable housing!

"The UK housing system is actually one of the best in the world, but only if you're relatively wealthy or have financial assistance from family. Yes, if you don't have these you can't afford to buy and are condemned to inflated rental prices forever, but if you can afford it the system is brilliant.'

 :chair:

TobyD

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#1583 Re: Politics 2020
October 23, 2021, 07:42:35 pm
Toby, I am not so sure about that as rich people in the US have lower life expectancy than poor french people e.g.

Would that have more to do with obesity by any chance?

TobyD

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#1584 Re: Politics 2020
October 23, 2021, 07:45:41 pm

This is like pointing out that some people have nice mansions during a discussion about lack of affordable housing!

"The UK housing system is actually one of the best in the world, but only if you're relatively wealthy or have financial assistance from family. Yes, if you don't have these you can't afford to buy and are condemned to inflated rental prices forever, but if you can afford it the system is brilliant.'

 :chair:

You might think that sounds ridiculous but it's perfectly true. The US has amazing healthcare that a lot of the population can't afford. The UK has plenty of houses, but noone under 50 can afford them either. I'm not saying both things aren't massively problematic, but it doesn't stop them being correct!

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#1585 Re: Politics 2020
October 23, 2021, 09:02:32 pm
"the test of a civilization is the way that it cares for its helpless members"; Pearl Buck



Nigel

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#1586 Re: Politics 2020
October 24, 2021, 01:14:49 pm
Totally agree with all those points. Mine was simply that people in the UK are bizarrely dedicated to the NHS, and hold it in an esteem it doesn't really deserve. This, combined with the constant comparisons with the US system and how terrible that is, prevents the change that's so clearly needed. Whenever any sort of private funding is mentioned people automatically assume it'll mean going with the US system, and it just doesn't.

What sort of private funding would be an improvement then, if not the US model?

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#1587 Re: Politics 2020
October 24, 2021, 01:25:15 pm
The Dutch system seems to keep costs low, but provision and quality high than the UK.

It's not *that* different from the UK system. In fact, I'm going to do a bit of reading about the differences. Basically you have to pay a basic charge, and you pick a "package" which give you some added cover, either physio, eye care etc.

Its still free at the point of use, and seems (but this is where I need to do some reading, never loved there so this is all second hand from my partner...) better care than here.

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#1588 Re: Politics 2020
October 24, 2021, 03:53:03 pm
The Dutch system seems to keep costs low, but provision and quality high than the UK.

It's not *that* different from the UK system. In fact, I'm going to do a bit of reading about the differences. Basically you have to pay a basic charge, and you pick a "package" which give you some added cover, either physio, eye care etc.

Its still free at the point of use, and seems (but this is where I need to do some reading, never loved there so this is all second hand from my partner...) better care than here.

Ditto with my experience of French healthcare, at least in a rural setting (Ardeche) and twenty years ago…
Although I do recall paying my GP and claiming it back, but not that that was onerous and I think there was a way around that when I was on unemployment benefit for a short period.
Things change, I know, but I recall it being much faster and better than the NHS of the day.
Not convinced the NHS is without scope for reform.

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#1589 Re: Politics 2020
October 24, 2021, 03:58:02 pm
The Dutch system seems to keep costs low, but provision and quality high than the UK.

It's not *that* different from the UK system. In fact, I'm going to do a bit of reading about the differences. Basically you have to pay a basic charge, and you pick a "package" which give you some added cover, either physio, eye care etc.

Its still free at the point of use, and seems (but this is where I need to do some reading, never loved there so this is all second hand from my partner...) better care than here.

I'm totally ready to accept that Dutch health system is better overall than UK but we should take into account that the Netherlands is significantly richer country than UK (> 25% higher GDP per head) and according to report above spends approx 33% per head more on health - given this you would hope that health system was better (though obvs thats not a given).

Not that this doesn't mean that there isn't space to reform and improve the NHS.

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#1590 Re: Politics 2020
October 24, 2021, 06:11:20 pm
I think its worth remembering that the quality of NHS services is variable depending on where you are. If you live in Sheffield you get access to some pretty fantastic acute hospital care and some okay health and social care. If you live in Grimsby the care is pretty bad and the services are in a much worse condition.

Basically the NHS is much better in all the places you'd expect it to be (big cities, south-east, south-west) and much worse where you'd expect it to be (northwest, northeast, coastal areas, rural North and Midlands, North Wales etc).

Like you might say A&E wait times are bad. And they are. They're way worse right now in NI compared to say Nottingham though. NI is looking at 40 hours in A&E if you are not in mortal danger (just a little mention, so if you fall off a boulder problem in NI right now, don't bother going to A&E unless your ankle is in agony etc).

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#1591 Re: Politics 2020
October 24, 2021, 06:43:28 pm

Not that this doesn't mean that there isn't space to reform and improve the NHS.

By dismantling the internal market and reversing the encroachment of private healthcare on publicly funded care maybe?

Efficiencies might start here, for example: https://www.theguardian.com/world/2021/oct/07/private-hospitals-treated-eight-covid-patients-a-day-during-pandemic-says-report

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#1592 Re: Politics 2020
October 24, 2021, 08:54:11 pm
The Dutch system seems to keep costs low, but provision and quality high than the UK.

It's not *that* different from the UK system. In fact, I'm going to do a bit of reading about the differences. Basically you have to pay a basic charge, and you pick a "package" which give you some added cover, either physio, eye care etc.

Its still free at the point of use, and seems (but this is where I need to do some reading, never loved there so this is all second hand from my partner...) better care than here.

I'm totally ready to accept that Dutch health system is better overall than UK but we should take into account that the Netherlands is significantly richer country than UK (> 25% higher GDP per head) and according to report above spends approx 33% per head more on health - given this you would hope that health system was better (though obvs thats not a given).

Not that this doesn't mean that there isn't space to reform and improve the NHS.

The GDP disparity is only a relatively recent, I'd love to nail it to brexshit, but it started a bit before then, but not long - so I don't think it's a valid reason for the disparity. The 33% higher funding probably is...

https://countryeconomy.com/countries/compare/netherlands/uk?sc=XE34


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#1593 Re: Politics 2020
October 24, 2021, 11:04:35 pm

The GDP disparity is only a relatively recent, I'd love to nail it to brexshit, but it started a bit before then, but not long - so I don't think it's a valid reason for the disparity. The 33% higher funding probably is...

https://countryeconomy.com/countries/compare/netherlands/uk?sc=XE34

I was more suggesting (possibly incorrectly) that the higher GDP was the reason for the higher spending on health and hence better service.  Interesting that the significant disparity in GDP developed over such relatively short period.

TobyD

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#1594 Re: Politics 2020
October 24, 2021, 11:06:31 pm
I think its worth remembering that the quality of NHS services is variable depending on where you are. If you live in Sheffield you get access to some pretty fantastic acute hospital care and some okay health and social care. If you live in Grimsby the care is pretty bad and the services are in a much worse condition.

Generally my experience is that the NHS tends to be excellent at emergencies,  and bloody awful at a lot of chronic conditions,  especially mental health. 

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#1595 Re: Politics 2020
October 25, 2021, 06:52:48 am
Really good back and forth over the NHS. I think a lot of it come down to:
Quote
Mine was simply that people in the UK are bizarrely dedicated to the NHS, and hold it in an esteem it doesn't really deserve.
I think it did deserve it and we have been repeatedly told it is better than everyone else's so we believe that. Ignoring mental health, chronic issues/quality of life procedures, it IS the best in the world...... for outcomes per £/$/€ spent. The sad fact is we want a better health system, we need to spend money on it and we are a nation adverse to both tax rises AND health insurance.
Quote
Whenever any sort of private funding is mentioned people automatically assume it'll mean going with the US system, and it just doesn't
That's a factor of our government. If you look at the current cabinet, would you expect a them to implemetn a Euro style system, on enact a fire sale of the NHS to their mates that'd make the PPE contracts look like value for money?
Quote
The US actually has pretty much the most advanced health care in the world
But quite different in approach. They have a very interventionist approach (makes more money) than the UK.
Quote
Generally my experience is that the NHS tends to be excellent at emergencies,  and bloody awful at a lot of chronic conditions,  especially mental health. 
I think this is spot on. I'm not sure this would be changed by privatisation though?

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#1596 Re: Politics 2020
October 25, 2021, 07:32:33 am
I don't think proportion of GDP spent on healthcare is especially meaningful. The US spends close to twice as much as many European countries with some form of national healthcare, but typically with worse outcomes (e.g. life expectancy, admittedly a crude measure). Having tried to deal with the labyrinthine bureaucracy involved in US health insurance I suspect much of that extra spend has nothing to do with patient care and a lot to do with profit.

And yes, when it is good, US healthcare probably is the best the world, but what does that mean when you can't access it? I have friends with "excellent" insurance through their employer who are still thousands of dollars out of pocket for non-elective surgery.

Edit: on per capita GDP, I was generally shocked to see it's a third higher in Denmark compared to the UK. I thought there'd be a gap but I would not have guessed it would be so big.
« Last Edit: October 25, 2021, 07:46:11 am by andy popp »

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#1597 Re: Politics 2020
October 25, 2021, 08:56:07 am

Edit: on per capita GDP, I was generally shocked to see it's a third higher in Denmark compared to the UK. I thought there'd be a gap but I would not have guessed it would be so big.

The U.K. is basically the Netherlands and Puglia glued together. Nine out of ten of NW Europe’s poorest regions are here, and the richest.

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#1598 Re: Politics 2020
October 25, 2021, 09:15:09 am
All this debate about health was originally due to covid restrictions being brought in to save the NHS.  At the end of the day,  the  craven self interest of this government is such that its probably not going to happen before the COP,  as that might be a bit embarrassing for Boris,  and spoil all the big corporate events hes looking forward to. 

Just wait until after its over in a fortnight. 

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#1599 Re: Politics 2020
October 25, 2021, 11:15:40 am
Galpinos has said most of what I would have done so I won't rehash it.

If you google any healthcare system ranking, the UK is always up in the top few. I've no idea how these rankings are worked out, and different ones give slightly different answers. But in all of them, any system that comes above the NHS spends significantly more. That appears to be the difference. As has been remarked, you would expect the Netherlands to have better outcomes if it spends 33% more per head of population! Anyway I managed to find a link to the relevant chart from the earlier link which shows these disparities (apologies for size).

It appears to me that actually the NHS does amazingly well considering that by any comparative measure it is being run on the cheap.

The other thing I takeaway is that something has gone very, very wrong in the US. They spend twice as much as every other developed nation, and they don't even have universal healthcare, never mind universal free healthcare like we do. Which is why we would be well advised to jump onto any creeping talk of privatisation to solve NHS "issues" from this government or their outriders in the Telegraph / Times / Mail, as like Galpinos I wouldn't trust them not to go down the US route. The solution is to spend more on what we already have.


 

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