NHS in a capitalist economy...

grizzly1911

lostinrates wrote: »

I have separate dog walking and gardening clothes...be
Us they are pretty much all I wear some weeks!

I know what you mean.

globalds

grizzly1911 wrote: »

I am not sure how you can cost out healthcare and set a rigid budget. You can probably have charge out rates for a typical knee operation not so easy for a cardiac intervention.

Something like 90% of prescriptions are free which would suggest that a good proportion of the population wouldn't be able to afford insurance or insurance wouldn't want to afford them. Perhaps the current cost, that would need to be recovered, is broadly reflected in taxation already.

Arguably those with the ability to pay, or through their employer, already do if they are concerned or want enhanced options.

Many routine items such as dentistry and eye care are already chargeable.

At the moment private cover cherry picks and doesn't take on all the liabilities. If it were to take on wholescale responsibility I doubt the treatment conditions for the majority would alter markedly. I also doubt that the taxation burden would fall enough for the average Joe to notice. Would we get effective competition? It doesn't seem to have brought the great benefits in much else that has been opened up.

Those that could afford the platinum level would continue to see the benefits as they do today.

I think it is insurance that offers the feedback needed for real costings.
It is there business in the end to determine risk and then put a cost up of what it will cost each individual or the state to cover that % of liability.

The figures that come back may be unpalatable and it may mean that some pragmatic choices have to be made ...But running a system that has no way of being funded and no practical way being put forward to achieve this is just another can kicking episode that will end up with misery for far more people in the future.

So a perfect example would be the present measles outbreak ....I wonder how many parents wouldn't have vaccinated if it would have had implications with either there families or there child's future insurance premiums ?

As I was trying to point out our health service is being asked to do the impossible and almost any lifestyle or preventative patterns of behaviour that could be implemented is almost impossible to more than ask people to do.

grizzly1911

globalds wrote: »

I think it is insurance that offers the feedback needed for real costings.
It is there business in the end to determine risk and then put a cost up of what it will cost each individual or the state to cover that % of liability.

The figures that come back may be unpalatable and it may mean that some pragmatic choices have to be made ...But running a system that has no way of being funded and no practical way being put forward to achieve this is just another can kicking episode that will end up with misery for far more people in the future.

So a perfect example would be the present measles outbreak ....I wonder how many parents wouldn't have vaccinated if it would have had implications with either there families or there child's future insurance premiums ?

As I was trying to point out our health service is being asked to do the impossible and almost any lifestyle or preventative patterns of behaviour that could be implemented is almost impossible to more than ask people to do.

Our health service provides a potentially open ended chance care regardless of background as you say. That said it does impose limits and restrictions on what it will ultimately provide.

With genetic testing that is coming along I wonder how long it will be before insurance companies make testing mandatory. I wonder whether they will even want to touch some risks and if they do whether individuals will be able to afford them.

globalds

grizzly1911 wrote: »

Our health service provides a potentially open ended chance care regardless of background as you say. That said it does impose limits and restrictions on what it will ultimately provide.

With genetic testing that is coming along I wonder how long it will be before insurance companies make testing mandatory. I wonder whether they will even want to touch some risks and if they do whether individuals will be able to afford them.

It is interesting you mention genetic testing.
The UK with a national health service could be one of the few places to argue that it is reasonable to use this kind of predictive science.

Even for insurance ..I think if it is combined with monitoring that reduces either the probability or risks of the consequence ..Then it is not a bad thing.

zagubov

globalds wrote: »

It is interesting you mention genetic testing.
The UK with a national health service could be one of the few places to argue that it is reasonable to use this kind of predictive science.

Even for insurance ..I think if it is combined with monitoring that reduces either the probability or risks of the consequence ..Then it is not a bad thing.

I'd not support higher NI contributions from people with greater genetic risk. However I would consider thesde controversial ideas.
Charges for appointments after one has been missed in any year.
Higher NI for drinkers, smokers and people who won't attend weight control courses or accept other help with thier problems. Higher Ni for idiots that won't vaccinate their kids.
Organ donors get to skip queues for treatment
Separate queues at A and E for drunks and sober people. :beer:

resilie

As a clinical NHS worker reading all this is so depressing!
Just to set the record straight on a few points raised:
"The NHS decides whether a treatment is too expensive" - not quite true; new medical treatments/drugs get evaluated by NICE or SIGN; they look at research evidence as well as cost benefit and then make recommendations; different NHS trusts offer different services (eg obesity surgery) but in general if NICE recommend something the trust have to find the money to pay for it....

Private=better care.... most private hospitals in this country are completely ill equipped to deal with emergencies or major complications.... most private hospitals perform elective surgery in low risk patients and at the wiff of any complication cry for help from the NHS... the stuff I have seen sent over from the Spires in this land.... any true emergency such as road traffic accidents, burst appendix, stroke heart attack- none of these are currently treated in private hospitals in ghe UK...They are currently not capable to do so

"Top dollar"- first I'd like to see the evidence that the average NHS worker is paid "top dollar" I know how much a HCA earns despite night shifts and weekend and believe me it's not great.... you would be hard pressed to find any other professional group who go through such prolonged training as hospital consultant... it usually takes at least 5 or 6 years of uni plus a minimum of 9 years of post graduate training before becoming a consultant but most take further time to do sub-speciality training, fellowships, research or higher degrees. A lot of specialist nurses have higher degrees and participate in research. It is usual to become a consultant in your late 30s or early 40s- around the time bankers start thinking about retirement. So after 15 years of training, night shifts, missing xmas, dealing with death gore exhaustion and a huge responsibility do I think they deserve to be well paid- hell yes. Plus I rather have a clever, hard working well paid doc look after me than make the profession so unattractive that all the kids with straight As go off to work in the city and leave us stocked with foreign trained staff who can't speak to nan due to language difficulties.....

Brassedoff

Not long. The system is already creaking at the seems. No one will. Face up to the reality. We live longer, survive illnesses and diseases that 30 years go would have killed most. They are coming up with new and more expensive treatments too.

The service remains free at the point of delivery for all (who are not health tourists). We either have to top up the NHS by having a two tier system that allows those who can pay the top up fund to move along a little quicker or a lot more faster than those who don't, whilst ensuring the really sick get in quicker than the fast lane.

Or, the government gives everyone who buys private health insurance (that has a 20% NHS tax) 80% relief.

You will either get a lot of extra funds in to pat for all these treatments, or you remove a large chunk off the waiting list.

The above works providing the Consultants that the British taxpayer paid to train are restricted on the amount of private work they do to accommodate the extra work from the private sector.

lostinrates

resilie wrote: »

Private=better care.... most private hospitals in this country are completely ill equipped to deal with emergencies or major complications.... most private hospitals perform elective surgery in low risk patients and at the wiff of any complication cry for help from the NHS... the stuff I have seen sent over from the Spires in this land.... any true emergency such as road traffic accidents, burst appendix, stroke heart attack- none of these are currently treated in private hospitals in ghe UK...They are currently not capable to do so
...

The a and e and other basic equipment point is absolutely right. If it were not so I would be going exclusively private for the sort of thing I am having.

Low level /elective point has not been my experience...certainly not in the initial stages of my treatment ten years ago. In fact, far from it. I accept this is not the mainstream of uk private medical provision... Out in the 'provinces' I am finding it is less so, regretfully. The treatment I had back then was on a different level though.

I will be having one procedure nhs in a couple of weeks that I really wish was available privately, its not complicated (lumbar puncture) and a second investigative procedure, certainly not by choice to have it, will be done privately.


Lack of availability doesn't mean 'not better' it means non existent or not available for comparison.


I am genuinely sorry you have found the reading here depressing, I think we probably all do. Tbh though, many people's experiences of health provision are pretty depressing. My nhs experiences have driven me away from seeking help and find my trying to manage a complex health situation pretty much alone in frustration and 'fear' and dread. The difference in experience private to nhs IS often very real, sadly.

grizzly1911

zagubov wrote: »

I
Higher NI for drinkers, smokers and people who won't attend weight control courses or accept other help with thier problems. Higher Ni for idiots that won't vaccinate their kids.

Separate queues at A and E for drunks and sober people. :beer:

Arguably smokers and problem drinkers already contribute more to the system through duty and VAT. On the basis that governments allow these drugs and tax them they heavily they accept some of the increased risk.

grizzly1911

Brassedoff wrote: »

We either have to top up the NHS by having a two tier system that allows those who can pay the top up fund to move along a little quicker or a lot more faster than those who don't, whilst ensuring the really sick get in quicker than the fast lane.

Or, the government gives everyone who buys private health insurance (that has a 20% NHS tax) 80% relief.


The above works providing the Consultants that the British taxpayer paid to train are restricted on the amount of private work they do to accommodate the extra work from the private sector.

In effect we do have a two tier system for minor and a good part elective surgery and ancillary treatments. You can insure and or pay privately. No one stops you.

On the basis that 90% of prescriptions are provided free it would suggest that most recipients of healthcare will fall under the NHS so unlikely that an 80% tax relief (or any tax relief) would be forthcoming.