Reform, and the death of the Tory Party

[Milzy]

What will reform do first if they got in? What chances have they got to get in?

 

[ebikeerwidnes]

"Would not object to" = it'll be policy, if they get in. And we can see from the US how quickly cherished institutions can be dismantled by even incompetent wreckers.

View attachment 12573

I reckon they would "privatise" it so that the companies run it and it would - eventually - work well

then 10 years later we would find that not the companies had a monopoly and no oversight and regulations were in place so now no-one could take over from them without spending millions
SO they would be free to increase what they charge the NHS per procedure as much as they want

after all - profit comes first for big companies

and then we would find that most of the companies that owned the whole structure were from abroad


bit like the Water companies were given the water supply systems and fixed a load of leaks and sorted out a lot of things

and now - over time - it seems that they have just used the assets to borrow money and have stopped investing in updates unless forced to - mostly by teh press - and sewage is just pumped into rivers due to "problems with the network"


it will go the same way if the NHS is "made more efficient by getting private companies to run it"
It could be done that way - but only with strong and well thought out regulation
and what do Reform hate most???

 

[briantrumpet]

I reckon they would "privatise" it so that the companies run it and it would - eventually - work well

then 10 years later we would find that not the companies had a monopoly and no oversight and regulations were in place so now no-one could take over from them without spending millions
SO they would be free to increase what they charge the NHS per procedure as much as they want

after all - profit comes first for big companies

and then we would find that most of the companies that owned the whole structure were from abroad


bit like the Water companies were given the water supply systems and fixed a load of leaks and sorted out a lot of things

and now - over time - it seems that they have just used the assets to borrow money and have stopped investing in updates unless forced to - mostly by teh press - and sewage is just pumped into rivers due to "problems with the network"


it will go the same way if the NHS is "made more efficient by getting private companies to run it"
It could be done that way - but only with strong and well thought out regulation
and what do Reform hate most???

I think it's generally accepted that the 'quasi market forces' of the 'internal market' that was introduced to the NHS (to try and harness some competition) was a disaster. (I suspect the excuse was "But it wasn't done properly - see Brexit).

I'd not give it two years before everything went completely pear-shaped. But that would be an open goal fot the wreckers, as then Reform (like the Tories) would say "Oh look how broken it is, we can't possibly afford to repair it, the only way to save it is by selling off what's left to private enterprise!" It's what the Tories did from Johnson onwards: break everything, and then claim that only private enterprise can save us. It's bollocks, and so obvious.

"Oh, but you're pretending that the NHS is perfect!!" No, of course it isn't, any more than the EU is perfect, or even democracy is perfect, but it's the least shoot option, in the circumstances. It's a never-ending task of repair & evolution to keep any health system efficient, affordable, and providing good outcomes overall. The US model, on average is still the most expensive in the Western world and with the worst average outcomes. Unless you're the CEO of a drug company, of a hospital business, of a health insurance business, or a doctor. Then you'll like the system.

Of course, private enterprise is (or can be) a great thing when applied in the right sort of way, but it's *always* exploited by the worst people when it gets involved in stuff that we can't do without, and when the aggressive capitalists manage to create an effective monopoly in an essential service. I'll grant you, they are *very* efficient in that regard.

 

[Xipe Totec]

What will reform do first if they got in? What chances have they got to get in?

Bye bye ECHR - and then they can do anything they want. Just like Daddy Trump.

I still think if Starmer makes it to the next GE, he'll run on the promise of a referendum on leaving the ECHR.

 

[Shortfall]

If only we could.look al health services in other European countries that use a mix of public funding and private provision and which often have better patient outcomes and then use them as some.kind of a template? But no let's not do that. Let's pretend that the only alternative is the American system.or some mutant version of a previously botched publicly utility and use that as justification for.pouring vast amounts of money into the failed monolithic system we currently have and that will.eventually bankrupt us.

 

[briantrumpet]

If only we could.look al health services in other European countries that use a mix of public funding and private provision for their health care and which have better provision and patient outcomes and use them as some.kind of a template? But no let's not do that. Let's pretend that the only alternative is the American system.or some mutant version of a previously botched publicly utility and use that as justification for.pouring vast amounts of money into the failed monolithic system we currently have that will.eventually bankrupt us.

OK, sure. That might be part of the discussion, as the UK is now distinctly mid table in Europe, neither disaster nor shining example. But I'd not trust a party that's being led by someone who'd like his nose superglued to Trump's generous buttocks and has praised the US insurance-based health system specifically.

https://www.numbeo.com/health-care/rankings_by_country.jsp?title=2025-mid&region=150

 

[briantrumpet]

Re bankrupting us, we're also mid-table as %age of GDP. Lower than France, which has similar economic woes.

https://worldostats.com/country-stats/healthcare-expenditure-of-gdp-by-country/

 

[Shortfall]

Re bankrupting us, we're also mid-table as %age of GDP. Lower than France, which has similar economic woes.

https://worldostats.com/country-stats/healthcare-expenditure-of-gdp-by-country/

View attachment 12601

Agreed, we're not unique in facing enormous problems with funding health services for an ageing population. However the NHS isn't delivering particularly well for us despite the enormous costs. Unfortunately we can't have a sane conversation about it in this country without someone from the Labour Party scaremongering about what the alternatives would entail.

 

[Pinno718]

We are below Czech republic, Estonia and Lithuania.
That's hardly a good yardstick. 'Mid-table' is a bit flattering.
We're a pretty sickly nation with poor diets and lifestyles and a growing percentage of elderly.
That may have something to do with the NHS being under so much pressure.
The problem is, addressing that and re-installing what was one of the founding pillars of the NHS, that being preventative medicine, doesn't get a lot of votes and would take longer than a term in No.10.

Personally, I would have means tested prescription charges for a start. I would install a panel that would concentrate on procuring medicine with the best VFM as often, we are paying the big pharmaceutical companies over the odds for drugs which can be sourced elsewhere.
Anyone over a certain pay grade should be paying for say, a doctor's visit. It's a statutory flat fee in Sweden for everyone. It's not expensive but it subsidises the system. If the richer one's want to go private, I have no issue with that except that if they are referred to an NHS facility, for any reason, their insurance company will be billed. If you opt out, you opt out comprehensively.
We expect Scandinavian levels of health care but we don't want to pay Scandinavian levels of tax*.

*STOP HERE. Skip the rest of this post.

...and we should pay more tax! Yep - more tax* but simultaneously remove or reduce all the back door taxes to lower the cost of living. Our taxation system is very regressive*.

Big companies profit from state welfare in that part time workers don't get the same pension benefits/sick pay/paid leave/maternity leave rights and part time employees often still claim Universal credit and housing benefit but pay very little in tax. For example. If employers had to contribute pro rata the same as full time employees, we would promote thousands into full time employment who would contribute to the taxation system as it's currently much more profitable for employers to employ 2 people working 15 hours per week rather than 1 at 30 hours per week. The two employees contribute negligible income tax and receive benefits.

*VAT, NIC's, fuel duty, fuel tax, council tax, TV license, road tax, inheritance tax, excise fees, customs fees (we need to join the customs union), capital gains tax etc etc
Imagine the boost to the economy of reducing VAT to 15%.

 

[Shortfall]

We are below Czech republic, Estonia and Lithuania.
That's hardly a good yardstick. 'Mid-table' is a bit flattering.
We're a pretty sickly nation with poor diets and lifestyles and a growing percentage of elderly.
That may have something to do with the NHS being under so much pressure.
The problem is, addressing that and re-installing what was one of the founding pillars of the NHS, that being preventative medicine, doesn't get a lot of votes and would take longer than a term in No.10.

Personally, I would have means tested prescription charges for a start. I would install a panel that would concentrate on procuring medicine with the best VFM as often, we are paying the big pharmaceutical companies over the odds for drugs which can be sourced elsewhere.
Anyone over a certain pay grade should be paying for say, a doctor's visit. It's a statutory flat fee in Sweden for everyone. It's not expensive but it subsidises the system. If the richer one's want to go private, I have no issue with that except that if they are referred to an NHS facility, for any reason, their insurance company will be billed. If you opt out, you opt out comprehensively.
We expect Scandinavian levels of health care but we don't want to pay Scandinavian levels of tax*.

*STOP HERE. Skip the rest of this post.

...and we should pay more tax! Yep - more tax* but simultaneously remove or reduce all the back door taxes to lower the cost of living. Our taxation system is very regressive*.

Big companies profit from state welfare in that part time workers don't get the same pension benefits/sick pay/paid leave/maternity leave rights and part time employees often still claim Universal credit and housing benefit but pay very little in tax. For example. If employers had to contribute pro rata the same as full time employees, we would promote thousands into full time employment who would contribute to the taxation system as it's currently much more profitable for employers to employ 2 people working 15 hours per week rather than 1 at 30 hours per week. The two employees contribute negligible income tax and receive benefits.

*VAT, NIC's, fuel duty, fuel tax, council tax, TV license, road tax, inheritance tax, excise fees, customs fees (we need to join the customs union), capital gains tax etc etc
Imagine the boost to the economy of reducing VAT to 15%.

Fuçking hell. I find myself in agreement with much of that. Don't worry Pinno, it won't last 😀

 

[AuroraSaab]

Big companies profit from state welfare in that part time workers don't get the same pension benefits/sick pay/paid leave/maternity leave rights and part time employees often still claim Universal credit and housing benefit but pay very little in tax. For example. If employers had to contribute pro rata the same as full time employees, we would promote thousands into full time employment who would contribute to the taxation system as it's currently much more profitable for employers to employ 2 people working 15 hours per week rather than 1 at 30 hours per week. The two employees contribute negligible income tax and receive benefits.

It's crazy that tax credits (now part of universal benefit) were meant to be a hand up to help people back to work but became an employer subsidy that helps them employ part time workers rather than full time ones.

 

[briantrumpet]

Agreed, we're not unique in facing enormous problems with funding health services for an ageing population. However the NHS isn't delivering particularly well for us despite the enormous costs. Unfortunately we can't have a sane conversation about it in this country without someone from the Labour Party scaremongering about what the alternatives would entail.

In other words, we're not unique in Europe... it seems to be a general problem of flatlining economies and ever more expensive healthcare. The NHS is no more 'failing' than any other, if the 'league tables' are to be believed. Politicians selling the idea of the panacea of private insurance are the ones whose Brexit unicorns somehow still haven't appeared. Odd that.

The citing of the US model so often is because I'd argue that it's because it shows exactly how it should *not* be done: the cost of good outcomes for wealthy people is paid by everyone else, both in monetary terms and in health outcomes, and it lays bare the way that capitalists will exploit the necessity of healthcare to extract massive profits while people are bankrupted or die.

I'm happy to look at European models as more balanced examples, though I don't think the tables listed above suggest that they are drastically different in terms of affordability or overall health outcomes.

 

[Pross]

Part of the problem is that whenever there is a suggestion of looking at how we run the NHS the talk is always comparing with the US (probably as that is the way that the politicians most vocal about changing the system are likely to want to go for their own personal benefit) but there seems to be a good case for looking at other options. Looking at the above the Dutch are getting the best outcomes whilst spending less than we do at present. We need to find a way where politicians can look at what others are doing better with a view to improving our 'free at the point of care' system rather than it leading to cries of pushing for privatisation. The NHS has been given some kind of holy status that means trying to make changes, even if they would genuinely improve the service, are treated with horror - that needs to be overcome somehow.

 

[Psamathe]

We need to find a way where politicians can look at what others are doing better with a view to improving our 'free at the point of care' system rather than it leading to cries of pushing for privatisation.

I'm a great believer in the NHS "free at the point of care" so certainly not arguing for atlernatives but I agree about analysing more that NHS vs US.

When I lived in France I had too much involvement with their state provided healthcare system (ultimately false alarms but caused fair involvement) and it was certainly interesting. nb my experience was several years ago so maybe things have changed. But, when I moved there you didn't have a registered GP and that caused issues as many French would visit one GP get a prescription then visit another next day and get a prescription and their one condition would mean duplicate visits (and they'd end-up with 3 sets of anti-biotics and only use 1). So it changed and you paid €20 to see your registered GP but got €19 refunded (through a very slick fast easy system).

If you needed more serious care there were set rates for different treatments eg (hypothetical numbers) kidney stones €1234 and you chose your hospital and pay what the hospital charged eg €2345 and claimed back only €1234 (Gov. set rate) from the state. Most of these set rates were below what most hospitals charged so you made-up the difference unless you took out "top-up" insurance and with that you decided what %age of the rate you want cover for (can't remember bandings as I never took it out) but eg you'd take private insurance to top-up to 120% of official rate.

But there were exemptions from this when Gov. covered entire cost eg many cancers.

So not genuinely "Free at point of care" but also a long way from the US model.

Remembering that I'm not proposing such a scheme for the UK, just noting how it works in France so we are not comparing like with like for NHS vs CPAM.)

 

[All uphill]

. Looking at the above the Dutch are getting the best outcomes whilst spending less than we do at present. We need to find a way where politicians can look at what others are doing better with a view to improving our 'free at the point of care' system rather than it leading to cries of pushing for privatisation

Could better health and less obesity, as a result of mass cycling?

And, before someone says it, yes, cycling deaths are going up in NL. That's almost entirely because of the increasing number of people cycling into their 80s and 90s.