[gerbilly]

>I would privatise it tomorrow.

I'm glad you aren't in charge then :-)

Sure there is going to be waste, but once you privatise, the 'waste' will continue in the form of profit taking by insurance companies and all the other private actors in the system.

I know it feels unfair that there is waste. But IMO profit in healthcare is another form of 'waste' anyway, one that is made worse by the fact that it distorts the incentives away from providing care.

[chimeracoder]

> Sure there is going to be waste, but once you privatise, the 'waste' will continue in the form of profit taking by insurance companies and all the other private actors in the system.

Profit-seeking isn't unique to private entities. State-run programs are still subject to the exact same economic forces; the difference is solely in how they're accounted for.

It's similar to the situation with state-run prisons: the profits are divvied up between the vendors who supply the prisons, the unions representing the correctional officers, and other entities who are required to make a prison actually operate. And even in state-run prisons, these entities have incentives to lobby for the expansion of the prison-industrial complex (which they do). Vendors, suppliers, and LEOs extract massive financial benefit off of the entire system, but because the program itself is state-run, we don't talk about that as 'profit'. Instead, we talk about that as the 'budget' (with a surplus/deficit).

But suppose we turned the state-run system overnight into a vertically integrated, private system, with all the roles served by the exact same people. That is, all the correctional officers are the same (making the same amount of money), all of the suppliers vendors are the same (but many are now owned by the private system). Suddenly, from a discursive (and accounting) perspective, we get 'profit'. The amount of money being traded hasn't changed. The steady-state flow of money hasn't even really changed[0]. The only thing that's changed is which entities we group together as units. But they all work symbiotically in the exact same way, no matter whether you view them as a single entity or a composite system.

As for the NHS - you absolutely bet that there is a profit motive amongst providers (and the agencies themselves). The language is different, and the way it gets assigned to the entities who comprise the system is different, but the fact that it's a state-run program doesn't mean that all that 'profit' magically goes back to the taxpayer.

[0] There would be an overnight, single-time transfer of cash due to the overnight privatization (same thing that happens anytime a company spins out a subsidiary into a separate private entity), but the ongoing cashflow would be the same.

[gerbilly]

>But they all work symbiotically in the exact same way, no matter whether you view them as a single entity or a composite system.

That sounds like a utopia. None have been seen in the wild. Factions can form inside vertically integrated systems as well.

I also never claimed that there can't be profit taking in the nationalized system.

I only said that if there's going to be waste, I'd rather have it come from a system that isn't structured to deny care, or to make it prohibitively expensive.

Nobody likes people who are cheap. Did you ever go to somebody's house for dinner where they measure out wine with a graduated cylinder, and put out tiny portions?[1]

How about people who a cheap with the necessities of care for their loved ones? I'd rather treat everyone at the hospital like royalty, and not be cheap.

We can afford it. Just cut back on true waste like astronomical defense budgets for starters.

[1] Excluding cases where the hosts are truly poor.

[zigzigzag]

The NHS is dripping with profit, everywhere.

The staff make profits. If they weren't making profits then someone would assess how much they needed to live and pay their bills and that'd be the amount they got paid. In practice they get paid, some of them like senior doctors get paid large sums of money that they can then spend as they see fit.

The unions make profits. They charge membership fees and then justify those fees by organising industrial actions in order to increase the profits of the staff.

The equipment manufacturers make profits. Often by charging wildly varying prices for the same goods to different hospitals.

The drug manufacturers make profits. They have to, otherwise they'd not be able to do the research they do. University research is really no substitute.

Without profit the NHS wouldn't exist anymore.

[gerbilly]

By profit I mean charging a patient for treatment.

Everyone should get paid of course, and even handsomely including doctors, but what I meant was that no private company should be able to bill a patient for treatment.

[zigzigzag]

You have a really weird set of arbitrary lines in the sand.

So it's totally OK for a single doctor to make huge profits off the NHS when they charge patients for treatment, but if those doctors form a company to share the load and amortise overheads, then suddenly it's a terrible evil that must be forbidden?

And don't get confused by simple word changes: when a doctor turns up at a hospital and does work in return for a large paycheque he is very much "charging a patient for treatment". The fact that the charges come in the form of taxes and take a long route to get to the patient's wallet doesn't alter the fact that the money comes out of the patient's pocket and ends up in the doctor's pocket!

[gerbilly]

>the money comes out of the patient's pocket and ends up in the doctor's pocket!

It comes out _partly_ from the patient's taxes, and the rest from everyone else's taxes.

The cost is spread. That makes a big difference.