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NHS privatisation: Compilation of financial and vested interests


Dale
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This list represents the dire state of our democracy. The financial and vested interests of our MPs and Lords in private healthcare. Why are these people allowed to be in charge of our NHS, to vote on a bill that they clearly have something to gain from. Who cares that they have put it in the register of interests. This doesn’t excuse their interests, it merely highlights clearly why they should have no part in voting for the privatisation of the NHS. It is privatisation, despite the media’s continued use of the word ‘reforms’. The question must be asked. Are they public servants or corporate servants?

 

For the list:

 

http://socialinvestigations.blogspot.com/

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Care to give a summary about what the proposed actually entails? So far, the thing I got from it is that the NHS will stop being fully funded by the government, and that the market is introduced as a way to improve efficiency and relief the government from the rising costs of healthcare. Right?

If that's the case, I guess the most important thing is how regulated the market will be. Will patients be blocked from having healthcare? Will insurers be able to drop certain kinds of coverage? What's the deal? It wouldn't be reformed if the current system is sustainable, IMO.

Edited by goDel
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The Welfare state is unsustainable to begin with. Population is getting older. There will be more and more people to be "welfared" and there will be less people to cough up the necessary taxes. The Welfare state is just another kind of pyramid game. As long as economies and populations grow, it works. But as soon as the economy lags and the (working) population stabilizes, or worse shrinks, the shit hits the fan. It was fun while it lasted. (Western society is in decline)

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I don't buy that the a welfare model is unsustainable. You just need to tax more, especially the wealthiest parts of society. Companies are making record profits and none of that money is going back to society.

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I don't buy that the a welfare model is unsustainable. You just need to tax more, especially the wealthiest parts of society. Companies are making record profits and none of that money is going back to society.

At least understand that there is a point where the demand on welfare can be much higher than the amount of taxes the taxpayers cough up. Obviously, when the population gets older the balance between income (taxes) and outcome (welfare) can get out of balance. No matter how much you tax the happy few.

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I don't buy that the a welfare model is unsustainable. You just need to tax more, especially the wealthiest parts of society. Companies are making record profits and none of that money is going back to society.

At least understand that there is a point where the demand on welfare can be much higher than the amount of taxes the taxpayers cough up. Obviously, when the population gets older the balance between income (taxes) and outcome (welfare) can get out of balance. No matter how much you tax the happy few.

Unemployment increases as technology progressively improves (I saw many more automated cash registers in my local supermarket the other day). This means that the entire economic system itself will crumble if people lack the purchasing power to purchase goods and services thus meaning that more people will rely on unemployment benefits which the government may not be in a position to assist with.

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It will be interesting to see how things develop. I don't share your pessimism. Sure, the aging population will be a challenge, but instead of dismantling the welfare model, look for alternatives and see if money can be funnelled from somewhere else. I don't know.

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I think as a transition towards a more socially sustainable economy, taxing the wealthy even more would be a good avenue - and aim to socialise as many areas of society as possible so they are not ruined by profit seeking corporations who only care about cutting corners and gaining the profits as a priority over human wellbeing.

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At least agree something has to change one way or another. The current model may become unsustainable pretty fast, if it isn't already. It isn't pessimism. It's simple economics. Things don't get paid out of thin air. Ask the Greeks.

 

taxing the wealthy even more would be a good avenue - and aim to socialise as many areas of society as possible so they are not ruined by profit seeking corporations

 

Ehm...what would the rich be able to pay, and what would your socialized state cost? What are the odds the rich can't pay for the things you want to socialize?

Edited by goDel
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At least agree something has to change one way or another. The current model may become unsustainable pretty fast, if it isn't already. It isn't pessimism. It's simple economics. Things don't get paid out of thin air. Ask the Greeks.

Simple economics, yes > but an economy tied to science/nature/sustainability? = no.

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The Greek problem is far more deep going than just welfare out of control. Re-structuring is obviously needed. But I don't like the trend of privatization everything, that will never end well.

 

I wasn't bringing the Greeks up because of their welfare state. It's because the lunatic amount of spending without having the kind of income which was needed.

 

It's about the privatization of healthcare, not the privatization of everything. And what kind of restructuring are you talking about?

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I am not enough informed to talk details. I was just talking in general sense, that re-structuring might worth a look in seeing how to keep healthcare viable for the general populace. And privatization is something that is being talked in other areas than healthcare, be it postal services or railroads and they rarely end up being so great as they are said to be when the government are trying to get rid of them. The whole notion that the "free-market" will automagically do things far better and more efficiently than the government is flawed. There are certain things that should not be done by the market IMO, they are healthcare, education, infrastructure (and military).

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As a health economist I should probably chuck in my two pence worth...

 

the reforms are basically packaged as "giving doctors power, by removing all the bureaucracy/management". In the UK there are a lot of people who think this is a good thing, they always moan about bloated councils/pointless management/lazy nurses (c.f. The Daily Mail, and their readership). The problem is that to some extent they are right, the size of our welfare state, our council offices and the cost of the NHS have all grown to unmanageable levels. With respect to the NHS, it is clear that reforms are needed, all the major unions and major political parties agree (although labour have never said what they'd do).

 

The aim of the proposed reforms are apparently to 'pass control to patients', pass 'budgets to doctors and nurses', and 'greater freedoms to hospitals'.

 

The problems with these are:

 

- patients are stupid, or at least, not very well, and most academic evidence suggests that patients don't value choice - they just want a good local service. They don't want a shit local hospital but the choice to travel for 2 hours to a good one. Also with the gov't wanting to cut a lot of evaluation/benchmarking measures and targets, people won't have a good idea of how good or how shit their providers are. Patients will have less information to go on, and be asked to make important decisions at every point in their care pathway.

 

- doctors and nurses take an individual perspective, they treat the person in front of them, and they are extremely good at doing so. they don't take a population approach, they won't say we should cut our cancer spending and reallocate to mental health services, major decisions which are real problems. they don't have the experience, skills or desire to do this job. we have a large and potentially inefficient system at present to allocate national and local funding, but giving it to doctors and nurses isn't the answer! The BMA (the main trade union) have said they don't want this, the Royal College of General Practioners (the union for the doctors most likely to be impacted by the changes) have said they don't want this. The NHS works well when people are enthused about their job, I'm sure we can all draw on good and bad experiences about the NHS, and in my opinion the good service is when people are doing the job they want to do. If the unions and staff don't want these changes, then I don't see how they'll be happy when they come in and how they'll suddenly find the £20bn in the next few years that they're being asked to do. Like at present, people will do the minimum needed to keep them in a job. Unwanted reforms just create bad feelings, suspicion and defensive behaviours, and a lot of frontline staff going off work with stress because they're being asked to do more and more, with less job security.

 

- finally, competition has been seen as a dirty word in the NHS, for 2 main reasons:

1. It leads to perverse incentives. Our US friends can I'm sure fill us in with details.

2. There is no evidence in any health care system that competition drives down the cost of health care.

 

One of the clearest examples of why I don't think competition would work is the fact that the most expensive patients in the service are those with lots of complex comorbidities. Those with diabetes, heart disease and depression, who need regular surgery, treatment and community support - who are on first name terms with probably 40 NHS providers. These patients at the moment receive a reasonably united package of care (although I admit it could be better). By introducing competition suddenly the package becomes very fragmented, the expensive patients are now the most undesired and they fall through the gaps because private providers won't touch them.

 

 

anyway, that was a poorly written rant, and only scratches some of the itches with this - but oh well! why the Lib Dems haven't stepped in I'll never know. Pure madness.

Edited by jhonny
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privatizing health insurance is fucking shit. Governments have to be responsible for some things regarding their citizens' welfare, and health is one of them. Anyone who thinks private health insurance is a good idea needs to take a long hard look at the US and what happened there.

To back up what jhonny said - the US spends the most per capita on health, and their outcomes are not reflected at all in that spending.

Health spending: http://www.kff.org/insurance/snapshot/oecd042111.cfm

Outcomes: http://www.openmedicine.ca/article/view/8/1

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"democracy" - http://www.guardian.co.uk/politics/2012/feb/19/david-cameron-nhs-summit-criticism

David Cameron was accused of deepening divisions in the health service by only inviting royal medical colleges and health practitioners that he believes will back his NHS reorganisation to a special summit at Downing Street on Monday.

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privatizing health insurance is fucking shit. Governments have to be responsible for some things regarding their citizens' welfare, and health is one of them. Anyone who thinks private health insurance is a good idea needs to take a long hard look at the US and what happened there.

To back up what jhonny said - the US spends the most per capita on health, and their outcomes are not reflected at all in that spending.

Health spending: http://www.kff.org/i.../oecd042111.cfm

Outcomes: http://www.openmedic...rticle/view/8/1

 

Indeed, I think the US spend twice as much as us per capita, but on pretty much every outcome measure we're better off. I'm not saying our system is perfect, but the general principles are in the right ballpark.

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privatizing health insurance is fucking shit. Governments have to be responsible for some things regarding their citizens' welfare, and health is one of them. Anyone who thinks private health insurance is a good idea needs to take a long hard look at the US and what happened there.

To back up what jhonny said - the US spends the most per capita on health, and their outcomes are not reflected at all in that spending.

Health spending: http://www.kff.org/i.../oecd042111.cfm

Outcomes: http://www.openmedic...rticle/view/8/1

 

The US model is not the one and only privatized model. At the moment I'm working in the Dutch health insurance system and I can tell you that it doesn't resemble in any way the US-model. And yet insurance is privatized nevertheless.

 

And there's only a couple of basic ingredients needed:

1. everyone is obligated to buy basic insurance, and is free to buy additional insurance

2. government defines what is part of this basic insurance

3. insurers are not allowed to drop or deny people from this basic coverage

4. insurers are allowed to deny people from buying into additional insurance

 

Privatized health insurance, in a way is nothing more than the government outsourcing the management of rising healthcare costs. Similar to what is tried in the proposed NHS bill. Insurers have a natural incentive to lower the costs of healthcare while keeping premiums low (in a well regulated market!!). In general, people have a tendency to choose a cheaper insurance (when quality is equal) and insurance companies are naturally looking for ways to minimize healthcare costs. But what makes the American market so bugged?

What is bugged about the American system (I'm over simplifying here!) is that the market is not well regulated. US Insurance companies make money by dropping coverage of people when they're already sick and in need of care, even though they have been paying coverage for who knows how long. And insurance companies are allowed to deny people from any kind of insurance. Even the most basic. So they can cherry pick to only allow healthy people the expensive coverage.

So the ways American insurers minimize their costs are arguably corrupt. At least from a moral point of view. From the legal point of view, the new Obama-care is a start to fix that system. But before Obama-care, the policies of the insurers were legal.

 

With the mentioned 4 basic ingredients much of this can be solved. With the incentives still in place, insurers are forced to come up with ideas to lower the costs of this basic care. And they're forced to do this in a competitive market. (How competitive it actually is, is an entirely new discussion.)

In a market like this, the insurer is the agent who studies the healthcare system looking for slack. Depending on the kind of slack, they can lower its costs in a number of ways. These range from investments in projects to implement more efficient care (eg. in hospitals) and investments into prevention, or on the other side have a more policy driven approach by controlling the conditions under which care is provided. An example would be in prescribed medicines where physicians must prescribe the cheaper alternative whenever there is one. In this market the privatized insurer is an active part of the healthcare system, without having the abilities to go into these morally sketchy practices which seem to be common in the US.

 

TLDR: yes, governments have to remain responsible for some shit (regulation regulation regulation). no, privatized health is not necessarily fucking shit.

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Too late to edit:

 

In general, whenever an insurer is messing with care on an individual basis something sketchy is happening. On an individual basis care is about the patient and the MD. Micromanaging patients by the insurance companies will only be of some kind of interest when dealing with the 20% of people who are responsible for 80% of the total healthcare costs. And even then macro-managing is preferred. The insurance company must never be in the chair of the MD. And the costs of micromanaging do not way up to stimulating macro improvements of the system.

 

also, thanks J.

Edited by goDel
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On the sustainability tangent: funnily enough there was an interview on TV yesterday with Tim Jackson about the sustainability problem of our current western society. He sketched a hopeful picture. But he never directly addressed the issues of the welfare state (rising costs of care, lower incomes of governments), imo. So please it with a grain of salt .

 

http://www.youtube.com/watch?v=NZsp_EdO2Xk

 

And a summary of his book "Prosperity without growth":

http://www.nfft.hu/d...summary_eng.pdf

Edited by goDel
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I wasn't bringing the Greeks up because of their welfare state. It's because the lunatic amount of spending without having the kind of income which was needed.

 

IMO it's important to understand the different constraints Greece is under as a currency user vs. a currency issuer.

 

Recommended reading: http://www.neweconom...f-euroland.html

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I wasn't bringing the Greeks up because of their welfare state. It's because the lunatic amount of spending without having the kind of income which was needed.

 

IMO it's important to understand the different constraints Greece is under as a currency user vs. a currency issuer.

 

Recommended reading: http://www.neweconom...f-euroland.html

 

I don't think I agree with

While we won’t go into details, most of the so-called PIIGS got into serious trouble only because of the global financial crisis—both because tax revenue fell while fiscal demands increased but also because many of them tried to rescue their financial institutions. All of that led to rapidly growing government debts; interest rate differentials (between troubled PIIGS and stronger economies such as German, Dutch and French) exploded. The vicious interest rate dynamics set in.

 

In the case of Greece, its entrance to the EU was already a hot item because of its financial deficits. Even before the crisis it was pretty obvious their spending was unsustainable. They were allowed nevertheless and could ride the bubble of free money for a couple more years. Sure, when that bubble burst the serious troubles became painfully obvious. But the point is, they were already present and to some extent known before. It was not clear to what extent because the Greek government had a loose policy in presenting their numbers, if you catch my drift.

 

At the moment they can't climb out of their problems by inflation like the US is doing. But inflation is a poor medicine. The actual solution is in making their economy competitive again. Arguably, a bit of inflation would help. But it takes a lot of talk to bring the Germans in a different state of mind when it comes to inflation.

Edited by goDel
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