[solar-ice]

Indeed; the reason people exonerate it is that the Tories have been threatening the population with a dismantling and privatisation of the NHS for over a decade now, and that's not what anyone wants. People want the NHS to work, to be funded and managed appropriately. A primary reason it doesn't is the Tories crippling it.

[rleigh]

> that's not what anyone wants

The NHS has been turned into what is effectively a state religion in some quarters. It's untouchable. It can't be criticised. It's immune to meaningful improvement and reform at this point. Yet everyone I know who works for the NHS has a litany of stories about the inefficiency and waste. And it consumes an increasing proportion of the GDP. Eventually, something will have to give.

Its been on an unsustainable path since its inception. It's always been in crisis and needed increasing amounts of cash. Cash that we taxpayers have no choice but to pay up. The NHS isn't optional, it's mandatory.

If we have the option to opt out of paying for the NHS and go private, many will do so. I already have to pay twice over. I pay privately through my employer's plan, and then again for the NHS. I suspect if there is the possibility of opting out and going entirely private, many would do so. At this point it's the only way to ever get a GP appointment for many of us.

The problem with the debate here is that it's always framed in terms of UK vs US funding models, both of which are horribly broken in different ways, and never looks at other European countries or other systems around the world, some of which have systems which work better and provide better health outcomes for less money. If we were to privatise it along French lines, for example, it might be a massive improvement all around. But that debate has never happened.

[neilwilson]

"I pay privately through my employer's plan, and then again for the NHS."

And yet it is the private system in the UK that is taking away scarce supply from the NHS making it more vulnerable.

There is a supply side limit on doctors and nurses, which means private healthcare works like the Fast Track queue at Alton Towers. All it does is allow people with money to jump the queue at the expense of everybody else.

And remember that since the inception of the NHS Primary Care, ie the GPs, have always been private businesses. Yet that is the bit that is completely on its knees at the moment.

This isn't a private vs public argument. It's far more fundamental than that. It how do we share out increasingly scarce resources in a country that is getting poorer.

[robertlagrant]

> And yet it is the private system in the UK that is taking away scarce supply from the NHS making it more vulnerable.

It's not a system doing it. Healthcare professionals are choosing to work for private companies instead of the NHS. If you would like to ban that, then say so, but don't pretend there's an amorphous system to blame.

[neilwilson]

There is an amorphous system to blame - too much demand and not enough supply.

Some of that demand has money, therefore the private system will take capacity away from the NHS to supply the money. Of course it will.

That is jumping the queue.

Therefore as a society we have to ask whether we want to uphold the NHS's founding aim: "Healthcare free at the point of delivery based upon need not ability to pay".

We can't fix the supply shortage by taxing the rich. But we can stop the queue jumping by constraining who private healthcare is permitted to treat and in what order.

For the record I don't like the Fast Track queues at Alton Towers either. That's not the British way. In Britain we stand in line - whether Lord or Leper.

[rleigh]

> how do we share out increasingly scarce resources

We make people pay for them. Like we do with every other resource on the planet.

Healthcare is something which should be accessible for all, and we can of course subsidise the less well off. But it still ultimately needs paying for.

[physicsguy]

The supply side limit is purely because the government chooses not to train sufficient staff. We have a government imposed cap to train 7500 doctors per year at University. Then when they finish, they do two years at FY1 and FY2 level, but there are not then sufficient places for all doctors to go onto a training programme. A friend of mine is applying for the January intake of anaesthetics this year for e.g. and there are something like 25 places in the entirety of the UK for that specialty. So people end up working as locums, working to fill gaps in rotas, which has a high hourly rate. Then, when they do finally manage to get a training place, they take a big pay cut and work more hours. That’s if we’re lucky - because plenty of them just go to Australia where the standard working week for a Dr is 40 hours, and many of them don’t bother coming back. But this is a problem created entirely by the government’s choices.

We also have a hugely archaic system in the Royal Colleges. In no other profession do we expect people to sit regularly very expensive professional exams, and expect the staff to fund them out of their own salary rather than them being funded by their employer. £600 a go is not unheard of.

[neilwilson]

"We have a government imposed cap to train 7500 doctors per year at University."

We do. And you know why. Because the NHS has no more capacity to train any more than that. In fact this last year it has struggled to do that because it was more interested in ensuring its staff had masks on properly than getting the job done. First year medical student placements in hospitals were the first to get the chop.

To train more people in any system, that system has to do less of what it is currently doing and more training. We can't afford that in the NHS, which is already struggling to meet demand.

Ultimately the problem is that we spent the seed cord in the 1990s, and we're struggling to replace it.

[aprdm]

Canada doesn’t allow for private practises and it’s in a bad place

[googlryas]

> It how do we share out increasingly scarce resources in a country that is getting poorer

In this instance, the resources are humans, and it seems you want to force humans to do something they don't want to do. If you want slave-doctors just say so. It worked for the Romans I guess.

[forgotusername6]

This is the argument I hate the most from Americans w.r.t. nationalised healthcare. It's unbelievable

[googlryas]

Except it isn't an argument against nationalised healthcare. The UK has nationalised health care and that is what OP is complaining about. I think it would be more an argument by OP against "nationalised healthcare with legal private healthcare".

The exact argument is "doctors/nurses are limited, and they aren't behaving how I think they should behave. Let's fix the system so they have no choice". I guess that isn't slavery, that is just funneling people into a single path which they clearly don't like, because they reject that path when they have literally more than one option open to them.

[andrewjl]

Who is doing the rejecting and regarding what path? What specific proposed fixes are you referring to?

[_benedict]

You are not paying twice over. Your private insurance is dramatically cheaper than it would be if it covered everything covered by the NHS.

You do have overlapping cover, but the most expensive cover (GP, long term chronic conditions, emergency care) are provided by the NHS. It’s far from clear that you would pay less if you had to cover the whole through a private policy.

[matthewmacleod]

I find this is a common and totally unjustified take. The NHS is fairly frequently subject to alteration and reform in various ways, and there is no real truth to the “piles of bureaucracy and waste” stories - it remains broadly pretty efficient as a healthcare system when compared with other developed countries.

You’ve also misrepresented the nature of private healthcare in the UK - this is almost universally not a replacement for NHS services. It will offer you things like faster GP appointments, consultants, and routine operations. It will not replace many of the specialist or emergency services offered by the NHS, leaving you dependent on it anyway.

A bigger “problem with the debate” is that we so frequently find people like yourself who are insistent on having some kind of “debate” without really knowing about what, or why.

[gpderetta]

All employer provided healthcare setups I have encountered in the UK do not even offer a GP replacement service [1]. You still need to go to your NHS GP and get an open appointment and then the insurer will redirect you to an approved service (where you will indeed get a faster appointment). Also most insurers do not cover most chronic problems (you'll have to fallback to the NHS) and are really meant to cover just acute issues.

edit: and of course you'll rely on NHS for any emergency.

[1] at least not without paying out of pocket for the significantly more expensive premium coverage. Some now offer phone consultations but you still need to go to the GP for referrals and prescriptions.

[rleigh]

> You’ve also misrepresented the nature of private healthcare in the UK

I mentioned that we don't have the right to opt out of paying for the NHS. It's not possible go entirely private. If you could opt out, you could pay that money to a private provider instead and entirely forego the use of the NHS. That isn't an option today. But it should be.

[simonh]

I have private health care through my employer, I've only used it once but it was very handy. I don't agree with your take at all, there's no way a private health care outfit could efficiently provide an effective emergency service across the entire UK for all possible injuries and illnesses, completely replacing or duplicating the NHS. The USA has tried this and it's an incredibly expensive disaster.

Employed middle aged workers in the USA pay about the same as we do for the NHS to support Medicare, Medicaid and CHIP through taxes, and then have to pay about the same again to actually get health care for themselves. Plus the system that costs twice as much as ours per citizen still leaves tens of millions of Americans without health insurance. It's utterly godawful. Our current system where everyone supports the NHS, and if you want top up services you pay for it, ensures solid funding for everyone's health care. The fact that my private care actually subsidises the NHS by reducing demand on it is a feature, not a bug. There's also the fact that private health care increases overall investment in health care, so in emergencies the NHS can call on private medical facilities which otherwise wouldn't be available. I know there's a fairness argument, but in practical terms our system benefits everyone.

[koshergweilo]

Yup, as an American this is a pretty accurate assessment for the most part. It's also worth noting that several states actually have different systems to close the gap for people who don't fit into the medicare-medicaid-chips safety nets. In California we have medical, which adds an extra tax, but does help a lot of people who would be uninsured get health insurance. Different states will have massively different levels of care and expertise available.

For what it's worth if you have the money you can get some pretty world class care here. My dad had cancer and due to my mom's really good (publicly provided mind you, she worked for the school system) insurance got my dad great care and he's still out an about to this day

[tehbeard]

And when you have a heart attack in the street, who's responding?

In this scenario, why should an NHS ambulance pick you up when you don't contribute? Surely it should prioritize those on public healthcare? Some poor lad whose leg is broken from a fall?

[ricardobayes]

Your insurance would pick up the tab in this scenario.

[ljf]

The question wasn't about the cost, is was 'who is responding'.

[XorNot]

"opt out" is how conservative parties kill public healthcare systems.

Because the public healthcare system winds up subsidizing the private one: private insurers dump bad risks onto it when they get too expensive too insure, after years or collecting the payments that don't go to the public system.

It's the definition of privatizing profits and socializing risk.

You want to opt out? You get to opt all the way out. You don't get to come back, it's a one way street. Still keen?

[physicsguy]

I’m Germany, that’s the way it works, once you choose to go private you cannot opt back into the public system. People sometimes do it if they don’t plan to stay in Germany though, usually if they are immigrants.

[detaro]

Depends on the age. Above 55 it's indeed quite difficult, under that you can switch back if you fall back into the required status (i.e. take a job with a salary under the limit)

[simonswords82]

I think if you’re forced to go private due to long nhs wait times the money you have spent on paying for the nhs via your taxes should be refunded to cover private care cost

[Teever]

Why do you think this should be an option?

[rleigh]

Why should it be an option? Because we live in a free country, and should be free to spend our money as we see fit. Even if others don't agree with it. Why should we all be compelled by the force of law to divert a huge fraction of our income to an organisation which is so ineffective and inaccessible?

We are forced to spend a significant fraction of our salaries on the NHS whether or not we want to. If we feel that this is not good value for money, or of poor quality, we don't have any real option of choosing to pay an alternative provider. Like all nationalised industries, it's inefficiently run because top-down administration of huge organisations blunts initiative and freedom of action. It's run by Whitehall and politicians, with little input from those actually doing the real work. And the result is that it's in perpetual crisis, with COVID having pushed it right over the edge. Is it really fit for purpose? I don't personally think so, and haven't for many years.

Competition is good for many reasons. It improves the quality and value of goods and services. The NHS has no real competition. There's no direct cost of failure, no direct cost to poor purchasing decisions, no direct cost for poor quality of service, and no real driving reason for improvement in the quality and efficiency of its services. They get the money anyway.

Other healthcare systems in Europe have fully private provision--you have the choice of where to take your money, even if you paid into a public system. If a particular hospital or clinic is providing poor or expensive service, you can take your money elsewhere which is better quality and better value for money. That's a very real incentive to drive improvement and efficiency. That is not the case for the NHS system. There is no choice, and the incentives to improve are minimal.

If there is to ever be any improvement in the NHS, there needs to be competition. The NHS should be somewhere you choose to have treatment because it's the best option, not because it's the only option.

[ricardobayes]

Even though I agree with your comment, I don't know of any European countries where you could opt-out from paying social security. Even if some small eastern european country has this option, it is probably unsustainable for a larger country (or one with more healthcare spending).

[DanBC]

We've had privatisation experiments in English healthcare for years.

Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess.

> It's run by Whitehall and politicians, with little input from those actually doing the real work.

If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.

[DanBC]

We've had privatisation experiments in English healthcare for years.

Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess.

> It's run by Whitehall and politicians, with little input from those actually doing the real work.

If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.

> If there is to ever be any improvement in the NHS, there needs to be competition.

What is "choose and book"? We tried competition, and it dramatically increased costs without doing anything at all to improve care. We're now spending considerable amounts of money rolling back some of that law.

[gautamcgoel]

Isn't your argument really an argument against paying taxes in general?

[ljf]

An average of £2,647 per person.

[ricardobayes]

I just don't know why that is, every piece of that puzzle I have met, was really efficient and generally doing a good job. Spain is now trying to fix this and pensions by doubling self-employed tax. UK should probably follow suit, UK self-employed tax is ridiculously low. 20% on profits until 50k pounds won't cover a functioning healthcare system (or pensions for that matter).

[yetanotherloser]

What on earth? UK selfemployment tax is far more aggressive than this and the tax authorities have been on an aggressive campaign against selfemployed people for many years, leading loads of people - including me - to give up selfemployment and end up paying LESS tax as a result.I miss selfemployment! but it doesn't bring enough benefits to justify being reamed AND demonised.

And fuck the NHS. Smash the shit out of it. We'll all die exactly the same number of times without it, but be healthier and happier on the way.

[Nextgrid]

I disagree with the threshold you mention. 50k£/year isn't exactly "rich", and even less so given the current conditions with regards to inflation, housing prices being through the roof, etc.

[nradov]

Governments shouldn't be providing anyone with pensions in the first place. Instead they should make defined contribution plans like IRA and 401(k) available to everyone.

[loriverkutya]

In the UK id you are self employed you still need to pay National Insurance which is as far as I know used for funding healthcare.

[yetanotherloser]

It's not reserved for anything and hasn't been for ages.

[nly]

Total tax on someone in the UK earning the median full-tike salary of ~£32K is actually only ~15%

[physicsguy]

… no it isn’t?

Someone with the default tax code would take home £ 25,539.52 which means they pay 20.2% in tax. It’s quite low by many countries standards but certainly not 15%.

[wongarsu]

The same Tories that wanted to increase NHS funding by 350 million per week? What ever became of that?

(excuse the gallows humour)

[binbinbinbin]

>that's not what anyone wants. People want the NHS to work, to be funded and managed appropriately.

No, they want cost-effective healthcare. Almost everywhere else in the world uses a mixed public-private model for healthcare, which IMHO keeps a lid on the excesses of government spending into the money pit of fully-public healthcare.

[_benedict]

The UK spends less per capita (PPP) than most other equivalent country's health system [1,2]? I never quite understand the "cost effective" arguments against the NHS. These costs include all of our private health care expenditure, which are surprisingly significant.

https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

[usrusrusrusr]

The two are not mutually exclusive; you can pay less for healthcare than other countries, and still get a bad deal.

Eg: It's currently almost impossible to get routine or early-stage healthcare. If I want a routine doctor's appointment, I have to phone every day at 8am when the next batch of appointments are released, and hope I get one. Last time, it took hours on hold, and attempts over several days, to get one.

[_benedict]

Your GP surgery is privately run, so in this case the issue is likely very much an issue of the supply of available doctors, and how your GP surgery chooses to operate its appointment system.

I believe appointments are now run more efficiently due to the backlog and changes in processes due to Covid, with the reason for an appointment usually submitted digitally first, followed by an efficient telephone consultation that is well prepared based on your submitted reason for needing an appointment, and a follow-up consultation as necessary. Perhaps your GP surgery in particular is struggling, or you are perhaps not engaging with the new approach.

I have been surprised at just how well functioning the health service is right now despite the incredible pressures on it, but perhaps my local area is coping better than others.

Importantly, however, this issue was broadly not present 10 years ago when the NHS was better funded to meet its needs, and was still cheaper than other countries. So the issue is not the NHS, but funding, which is also corroborated by our relatively low level of health spending.

[thrown_22]

The left has somehow ended up as the party of the political managerial class instead of the working class, this is one of the best explanations why we're in such a weird place where the socialists are all trust fund kids who would rather have the working class arrested than talk to them.

[ben_w]

If the (UK) left is the party of the political managerial class, what is the (UK) right? When I'm feeling particularly sarcastic I might call them the party of dilettantes, but is that apt?

[rleigh]

Oddly, things kind of flipped around (in very broad terms). The left is where some of the well-off urban middle classes are, along with the far-left socialists. The right is where the less well off but working are, along with some non-urban upper- and middle-class voters. Because for a lot of working class people (primarily those who work, and aren't living off state support), they have been entirely abandoned by Labour after being treated as guaranteed votes for decades. This is a big part of what the so-called "Red Wall" is. It's socially conservative (small "C") workers from traditionally Labour constituencies. People who have aspirations and don't want to be held back.

While this wasn't previously the case, the spatial and socioeconomic patterns are increasingly similar to that of the Democrat/Republican voters in the US, from what I can tell. The leftward travel of the Democrats is a large part of that. But the left/right inversion in the UK has been slowly coming for decades, but the FPTP system hid that in the outcomes.

[zahllos]

Agree. As I once had it explained to me, "I don't choose parties any more, I just use my best guess as to which one will mean I take home more of my salary".

There's also the European angle. Those who want to work likely faced competition from EU workers and generally feel hard done by when it comes to globalisation. After all, if you worked in coal, steel, car manufacturing or your family did, quite likely you, or a relative, has lost a good portion of that work to cheaper manufacturing abroad. Which is more appealing: Labour, who prevaricated on Brexit, or BoJo, who simply said he'd do it? It isn't all that different to 'America First' in its appeal.

There probably wasn't any way to avoid the demise of coal, especially given our need to combat climate change, but did Labour provide an alternative? During the 2000s, Labour massively expanded higher education but also increased 'student debt', and only paid lip service to apprenticeships. If you're working class and working/aspirational, likely your budgeting is quite strict. Things like 'debt' and 'loans' generally mean 'trouble' and not a solution.

I agree this is broad strokes, but Labour has a problem in that it no longer actually represents its traditional demographic.

[pasabagi]

I think the idea that working people were feeling the heat from eastern european competition is a bit simplistic. Most industries have been facing a 'skills shortage', so people are generally aware that the health of their companies, and therefore their job security and career progression, are essentially limited by the pool of skilled labour. That and, working side-by-side with people from all over europe, people tend to feel a great deal of affinity.

The typical profile of a brexiteer is somebody retired, not somebody in employment, and I think the reasons are largely ideological, rather than practical; polling showed people who supported brexit would still do so if the hypothetical included economic pain.

[zahllos]

It is a little bit simplistic, of course, but any such statement will be.

That said, I stand by what I said. If you look at maps of brexit voting tendency, you'll see they map quite heavily onto rural communities and former industrial heartlands. My explanation for this is that they don't see or feel the benefits of the EU and globalisation. But we didn't have a referendum on who wants globalisation to end, we had one on the EU, and so they took what they could.

> The typical profile of a brexiteer is somebody retired, not somebody in employment

I find this slightly weird stated so definitively having just argued I was being simplistic. I'll lay my cards on the table. I'm British but took advantage of free movement, so I've been party to more conversations on brexit than I really care to think about both back in the UK and here. Trust me, however, this is not an accurate statement: there are plenty of people with jobs who voted for brexit and have strong opinions on it. You don't need to take my anecdata on it though, we can look at a study https://yougov.co.uk/topics/politics/articles-reports/2016/0... - to put this into words:

- of every 100 18-24 year olds who voted, 29 of them voted leave. - of every 100 25-49 year olds you meet, 46 of them will be leave voters. - of every 100 people retirement age or above 36 in 100 you meet will have voted remain.

I find the 25-49 year old bracket overly broad, personally. The vote flips at 50+, but I suspect it would flip slightly younger based on my own experience.

But either way, it can't categorically be stated that all brexiteers are retired people. Actually I can lay further cards on the table: I used to do statistics as a job. So I take issue with the phrase "older people with fewer qualifications most likely to have voted brexit" used on the table I am quoting. Older people yes, but age also correlates with access to education, since my grandparents left school at 15, so there's a significant confounding factor here. I'd be interested in a more detailed breakdown, and I find the "and uneducated" part to be problematic/needing more evidence.

To come back to my point, I was offering a very qualitative interpretation of an extra factor I think encouraged previously core labour voters (in places that have returned labour MPs for about as long as there has been a labour party to choose) to switch allegiances in 2019. I agree with the fact labour does not represent them any longer. Brexit is part of, but not all of, that: I'm adding that Labour had an unclear stance on brexit, whereas these regions tended to vote more strongly for brexit.

This is obviously my opinion only, offered without guarantee or warranty.

[throwawaylinux]

https://www.independent.co.uk/independentpremium/long-reads/...

https://www.theguardian.com/commentisfree/2022/may/10/starme...

I know this is brushed off or denied by the intelligentsia, and I know the ruling class (no matter what the party) never worked for the interests of the people but themselves, but nevertheless the working class is turning to conservative politics. The really sad thing is very few people on the left seem to be honestly asking why. What is their party doing so wrong that the least advantaged working class is voting for the parties traditionally associated with capital? Instead they seem happy making up feel-good stories about "the horrible uneducated racists voting against their own interest" to tell one another, and that is about the extent of their intellectual curiosity on the matter.

[thrown_22]

The right has no identity right now, which is why someone like Trump could take it over.

Depending on what happens in the next few years it could well be that they become the party against power. Which would be a rather interesting inversion from the last 40 years.

Which raises a lot of uncomfortable questions for people whose world was informed by Reagan, Thatcher and Bush.

[aaaaaaaaaaab]

The party of old people and the underclass.

[eunice]

boomers obsessed with manufactured culture war garbage

[starkd]

Indeed. A lot seem to have lost the urgency of meaningful reform, because they don't believe it can be. They are out of ideas and unable to build the momentum to get anything passed. But they already have theirs, so ...

[rcarr]

The biggest (and, rather oddly, rarely discussed) problem for the left in the UK is actually Scotland. Before the SNP rose to power, Scotland used to be a Labour stronghold. In 1997, Tony Blair's Labour had 56 seats in Scotland. Today, Labour have just 1.

Now that all of those votes go to the SNP it makes it extremely difficult for Labour to get a majority in the Commons along traditional ideological lines. There just aren't enough swing seats elsewhere to really make up for it. 200 seats haven't changed hands since WW2.

Seats gained/lost by winning party in elections since 1966:

1966: Labour Win, 47

1970: Conservative Win: 77

1974: Labour Win: 14

1979: Conservative Win: 62

1983: Conservative Win: 58

1987: Conservative Win: -21

1992: Conservative Win: -40

1997: Labour Win: 145

2001: Labour Win: -6

2005: Labour Win: -48

2010: Conservative Win: 96

2015: Conservative Win: 24

2017: Conservative Win: -13

2019: Conservative Win: 48

Current Seat Breakdown:

Conservative: 357

Labour: 200

SNP: 44

Lib Dem: 14

Plaid Cymru: 3

Alba: 2

Green Party: 1

NI parties: 18 (never been held by Labour or Conservative as far as I'm aware)

Speaker: 1 (politically neutral so irrelevant)

If SNP and Alba (Scottish Parties) are taken out of the equation entirely the way Northern Ireland currently is, Labour has only 18 seats that aren't held by Tories that they could potentially win. 326 seats are needed for a majority. That means Labour, in a best case (and very unrealistic) scenario where they gain all the seats from the minority parties, would need to gain 126 seats, with 108 of them coming from Tory seats in order to form a majority government.

I don't have the data going back past 1966 but looking at what we do have, a seat gain of more than 100 has only happened once: Tony Blair's 1997 win with 145 seats gained. 7 of those gained seats were in Scotland but Labour already held 49. In 1997, Scotland had 72 Westminster MPs but today, due to the redrawing of boundaries, it now only has 59. In total, Labour had 56 seats in Scotland. This means Labour held 78% of Scottish seats, which would equate to 46 seats today.

This is the real reason why Labour has had to become more and more Tory. To make up the deficit they either need to win back seats from the completely dominant Scottish National Party or win Conservative strongholds. They see the latter as more realistic so it's become their focus. When Scotland's seats are essentially out of reach of Labour, the UK becomes a de facto 1 party Conservative state.

It is absolutely bizarre to me that Labour won't make proportional representation and cross party co-operation a key part of their platform. Unless there are some seriously major shifts I can only really see Labour gaining power again through a minority/coalition government. Even if another right wing party such as the Brexit party emerged to splinter votes from the tories, Labour is still looking at a minority government. They simply can't gain enough seats unless they win back Scotland. This is why they are so reluctant to engage with the SNP because if Scotland really does leave the union, Labour probably won't be seeing power again unless there's electoral reform, a revolution or the tories mess up something up so badly that literally millions die. But by that point, they will have probably been in power so long (and absolute power corrupts absolutely) that they'll have the elections rigged autocracy style so even that may not matter.

https://www.electoral-reform.org.uk/latest-news-and-research...

[blibble]

people have been saying the NHS is 24 hours away from being privatised by the tories for 50 years

[ZeroGravitas]

Including the Tories:

https://www.independent.co.uk/news/uk/politics/jeremy-hunt-p...

[origin_path]

That's what lots of people want - I can assure you, I know quite a few - but the British left attacks anyone so viciously and nastily that they aren't ever going to admit it to anyone seen in the vicinity of a Guardian.

The NHS has collapsed since COVID. No, it isn't due to lack of funding, that's a lie. NHS funding has increased massively under the Conservatives who haven't talked about even limited privatisation for the last decade or more. The reason it collapsed is that rigid commands and control systems cannot cope with change and the NHS was already dysfunctional before that. When they emptied the hospitals they created a massive backlog that they already knew they could never catch up on even with more funding.

At any rate it's irrelevant. The excess deaths are much more likely to be vaccine linked despite the collapsed state of the NHS. The timing, causes of death and split between vaxxed and unvaxxed doesn't really work for the theory it's lockdown caused.

[cirrus-clouds]

NHS funding has increased massively under the Conservatives

That is simply not true. The Conservatives came to power in 2010. Here's what the The King's Fund [1] has to say on funding:

"In the decade following the global financial crisis in 2008, the health service faced the most prolonged spending squeeze in its history: between 2009/10 and 2018/19 health spending increased by an average of just 1.5% per year in real terms, compared to a long-term average increase of 3.6 per cent per year. These pressures were not unique to the UK, whose public spending on health care as a share of GDP is above the EU average, though lower than several comparable nations, including Germany, France, Denmark and the Netherlands." (Source: https://www.kingsfund.org.uk/projects/positions/nhs-funding)

[1] The The King's Fund is an independent charitable organisation working to improve health and care in England.

[MagnumOpus]

To put that 1.5% annual real-terms budget increase into context:

In the same decade the proportion of people aged 65+ increased from 16% to 22%ish of the population, an increase of a third. Since these are the people who consume the vast majority of NHS resource, the actual age-adjusted funding has been shrinking steadily every year.

[origin_path]

But we're not talking about whether budgets increased by as much as random HN commenters feel would be ideal, I said funding had increased massively i.e. in absolute terms, which it has.

Any discussion of the NHS budget has to accept this reality - the British state is already deep in deficit for decades and had built up incredible debts just trying to keep the NHS budget rising, which it always has. To say the NHS would works better with more money is simply to admit it's broken and can't be fixed, because the government can't even afford the current levels. Especially not after the attempts to stop COVID blew debt and inflation through the roof.

[Dagger2]

We were talking about the NHS being underfunded, and you said that funding has increased in absolute terms. Both of these things can be true simultaneously.

[origin_path]

But, we were not. This thread starts with the claim that "NHS funding has massively increased under the Conservatives" (true) and someone else saying "that's simply not true". But it is true.

NHS apologists always seem to try this switcheroo: someone will point out NHS funding has massively increased - an objectively true claim - and then they'll be accused of lying, by someone who claims it's "underfunded", an entirely subjective and different claim. As you point out, both can be true, but the latter is not disproof of the former nor even a well defined statement.

[origin_path]

You realise that this quote supports what I just said, right? It takes massive funding increases to consistently increase budgets year over year for over a decade by that much after inflation adjustment given how huge the NHS budget already is. Go on, compare the budgets between those periods in actual pound sterling terms and then think about how much more tax had to be raised to sustain that (or rather how much debt had to be issued).

[benj111]

Waiting lists are going down. They just cleared the backlog of people waiting 3 years for treatment

[MagnumOpus]

Sure, and the excess deaths above help a lot in doing that.

Still, while waiting for patients to die is an cheap way to shorten backlogs, it does leave not instill confidence…

[benj111]

Except people don't tend to die from needing a hip replacement or other quality of life surgeries. The urgent things tend to get done first.

[origin_path]

They die of old age instead? Not really better. The point of the NHS is to treat people, if you have to wait three years for treatment that's the same thing as collapse, it's not really different from the user's perspective.

[benj111]

Are you suggesting the 3 year backlog has been cleared in 6 months just from people dying of old age?

I agree a 3 year wait is unacceptable, but 2 years of that was covid. Covid has largely passed so they are now getting through the backlog.

[phtrivier]

I'm genuinely interested in the link to the data about the vaxx / unvaxxed split.

I know the most ardent antivaxxers are going to explain every death in the next 30 years by the vaxx ; but the numbers would be so staggering that I suspect plain old counting would help.

[origin_path]

Traveling today so don't have easy access to my bookmarks with that data (is heavily buried in UK govt websites) but here's an analysis of the excess death data that also shows ambulance call outs jump permanently and significantly in April 2021

https://nakedemperor.substack.com/p/massive-increases-in-exc...

A lot of it is due cardiac reasons. You can also look at when excess death went up in younger age ranges that weren't affected by COVID and see that it starts at the same time the vaccine programme reached them. Hard to explain as lockdowns given they'd been happening for a year by that time.

Edit: Here we go. here's an analysis of deaths by vaccine status for the UK:

https://bartram.substack.com/p/deaths-by-vaccination-status-...

N.b. The way you calculate the population size heavily affects the meaning of this data and the government itself doesn't know what the population is, so there's plenty to debate here, but you can see why the author concludes there should be an investigation. He uses a conservative pop estimate based on official NHS registrations (because the ons estimate is definitely wrong) and plots the graph of the difference by status at the end. So you can set that for everyone under 75 the vaccines appear to be making things worse not better.

[cies]

> I know the most ardent antivaxxers are going to explain every death in the next 30 years by the vaxx

In same vein the "every death" (or hospitalization) during the covid pandemic was due to covid and/or lack of vaccination.

I add quotation marks because in both cases I do not believe it's true.

[starkd]

What makes you so sure government bureaucracy is even capable of doing this? It never had a great track record to begin with.

[Folcon]

I don't wish to be snarky, but you are aware that the NHS as an institution has existed since the late 1940's and has been working reasonably well for a long time? An institution does not become beloved by the public for failing to provide a good standard of care for a long enough time that people become used to it doing so.

So when you say:

> It never had a great track record to begin with.

Are you talking about government institutions in general or the NHS? I maybe wrong, but I suspect you're speaking of US institutions which are an entirely different dynamic to UK and European ones.

If you are speaking of the NHS, then please outline how it doesn't have a great track record commensurate with its lifespan.

[Aerroon]

>An institution does not become beloved by the public for failing to provide a good standard of care for a long enough time that people become used to it doing so.

Here's how you do it: you pump unsustainable amounts of money into the service over time. This allows you to offer a great service until in the future you can't pump enough money into it anymore. But that's a problem for the future generations. Those future generations were funding the previous generations all the while, but won't get the same benefits themselves.

An ever increasing percentage of GDP is being poured into the UK's NHS. At some point it's going to be too costly and the young generation at that time will have to pay for it, but won't get the same level of service themselves when they're older. They will be the ones left holding the bag.

I don't think there's a politically viable solution to this though. The problem with this model is that you're effectively borrowing from future generations, but the system takes so long to reach actual unsustainability that people will grow up with the feeling that the system is great.

[ljf]

Is £2,647 per adult per year an unsustainable amount? How much is is OK to spend on the military? On roads? On tax breaks for energy companies?

Don't forget healthcare isn't about you, it is about society and if you don't care about society just think of it instead as having healthy employees and customers, who aren't ruined if they fall ill, and therefore have cash to spend...

[harvey9]

the uk spends far less per capita than the usa. can you explain what you mean by unsustainable?

https://en.m.wikipedia.org/wiki/List_of_countries_by_total_h...

[aceazzameen]

What's a better system then? Because it certainly isn't privatization. And correct me if I'm wrong, but I'm assuming that's what you're arguing for.

>you pump unsustainable amounts of money into the service over time. This allows you to offer a great service until in the future you can't pump enough money into it anymore.

This is how every growth based juggernaut business works as well. Quality of service always goes down to continue growth of profits, especially after you've crushed the competition.

IMO, healthcare of the public should not be a profitable business. Or the business will always find ways to squeeze their customers who simply need care for the health.

[starkd]

It's not so much the profit that matters, in principle. But profitability does provide some constraint and guide to resource allocation that a public institution is still grappling with how best to do. Private institutions can go under and be replaced more easily. Again, not perfect, but you never see the same creative destruction in government institutions.

[starkd]

I think general survey results are probably a poor metric to use in evaluating the success of a healthcare institution. Sure, at any point in time, most people should be able to get what they need, but the serious cases, or anything out of the ordinary, is a much smaller percentage of cases for any given year. Anecdotes of waiting lists and the rationing of care (e.g. delaying services to the start of the next fiscal year when new money gets distributed) have been notorious for years now. This dissatisfaction only reveals itself over time, where it personally affects a greater swathe of the people. The pandemic accerlated this, but it shows how ultimately unsustainable it is.

Healhchare is tricky, because treatments are not one-size-fits-all. Large institutions are rigidly setup to deliver a product, a product that is ever changing, as new treatments are always being refined and added. When it was created it was set up to deliver products that were new 50 years ago, but the structure is inherently slow to evolve. But the private health insurance in UK does not have these problems. More effort could be made at growing the economy in such a way that rising incomes allow people to purchase the private health insurance. It's not an immediate answer for many, but it definitely beats throwing more money at a bureaucracy that cannot adapt.

[ChrisLomont]

Isn't it possible that demographics have changed enough that funding requirements have changed enough that the 1940s-2000 or so system is no longer viable?

I know the demographics in the US has vastly changed some cost models over that time, making some earlier social program hit major funding problems through no evil from govt actors.

[Folcon]

The demographics have changed, but they take that into account in terms of how they handle and manage care.

There's a lot of thinking and work that goes on to cover working out the changing needs of your population that has to be handled by any well managed healthcare service.

In the NHS specifically I am aware that they also have change management procedures that exist to try and understand how to provide continuous improvement as needs and situation change.

That's not to say things are perfect, by any stretch of the imagination. For example the NHS still has a big blindspot when it comes to tech. Most people aren't willing to take the effective pay-cut of being a techie and working in the NHS, a lot of people inside the service don't really respect people with tech skills and there's still a bit of a holdover of not paying much for anyone that isn't a doctor.

That's not to say the situation remains static, some doctors for example are slowly accumulating tech skills as a result, so what will probably happen is that success for a tech person in the NHS is going to require a prerequisite medical degree, at least in the near term.

Which though I don't think it's the best strategy, I can't also argue it's a terrible one to expect people who provide tech services into the NHS have a reasonably high level of domain knowledge.

This is a large institution with a substantial mandate, we should expect to pay a reasonable amount proportional to what it provides us. The fact that it's substantially cheaper than other healthcare services while still providing a very high quality of care leads me to believe that it's doing a pretty good job meeting that mandate.

So I don't think blindly questioning it without taking such things into account is helpful, nor do I think that pointing to costs as being "too high" are helpful without considering what is happening and why they are being paid for in the first place. Chesterton's fence and all that, it's not enough to just cut costs, you have to ask what doing so gains you. There are too many social programs which we cut because "spending less is good" without asking if the spending actually gives us a positive return as a society.

[starkd]

One common complaint from doctors (at least, in the U.S.) is the need to hover over a laptop all the time that takes time away from talking to the patient. A big problem as I've heard of a number of doctors retiring early because they don't feel as though they are even treating patients anymore, they are slaves to a console. (And these are not old doctors nearing retirement anyway.)

Personally, I think we've become a little too tech obsessed in thinking every problem can be solved with IT. Digitizing records only feeds a surveillance state anyway and can be dangerous (for other, obvious, reasons).

[DangitBobby]

Well, doctors are mainly hovering over a laptop to justify their treatment plan to insurance companies anyway. They were not implemented because someone thought they would improve quality of care.

[jeromegv]

They have actively worked at crippling it. Now that it’s crippled they tell you.. oh but surely the government can’t fix it, we need private enterprises to fix it!

You walked right into it.

What makes you think private business are capable of delivering something cheaper than what the government can do? The most expensive health care in the world is private.

[Folcon]

To be honest I'd be ok with private healthcare if they had to also obey the same constraints as public healthcare.

IE they had to provide care to everyone at a reasonable price.

I'm deeply suspicious of healthcare that gets to exclude people for cost reasons.

I too can provide great healthcare if everyone is mandated to pay me for my services and I get to exclude those I treat, that's a great business, the healthy pay and I exclude the sick, what wonderful pure profit business!

The insurance model bothers me for that reason, they really shouldn't be allowed to exclude anyone, if they're taking on the business of healthcare, then that's that, they are providing a utility service, which means they supply to everyone and they make money by spreading the cost between everyone.

There are nuances to that, but practically that's the goal they should aspire to, but unfortunately that model isn't the most profitable.

I mean take a look at the original US health insurance that existed:

> The first plan guaranteed teachers 21 days of hospital care for $6 a year, and was later extended to other employee groups in Dallas, and then nationally [0]

That insurance model worked, it just happened to get outcompeted by entities who were willing to undercut them by aiming to capture only the most healthy people, which is in effect a tragedy of the commons.

Which is a real problem in my book, I'd be fascinated to see what innovations a private company could come up with under that model. We might have missed out on a whole slew of interesting ideas if we kept going down that route, which would still have been a pretty profitable business and would have been a great success for those who do believe that the private space can do healthcare better.

As it stands I don't believe the current private model meets that criteria as it fails at the first hurdle of being a health care service, it doesn't care about health.

So it seems like the choices are bad private care, good public care and bad public care. So yea, I'm leaning to the good public care.

- [0]: https://en.wikipedia.org/wiki/Blue_Cross_Blue_Shield_Associa...

[raffraffraff]

Exactly. Why would it be cheaper or better to run healthcare as a for-profit business? If you have to take a profit, then by definition there's less funds available for the actual service.

[robertlagrant]

The point of private enterprise is it has to cost less or be a better product to survive, which is why things like cars are unbelievably better than they were 50 years ago, or even 10 years ago.

E.g. saying a state-run car company would've done better because all that profit money would've been perfectly allocated is not right. Otherwise the government's perfect decision-makers would be starting car companies left and right and making a fortune, instead of working for the government.

[MattPalmer1086]

Only if there is both competition and consumers can make informed judgements on the service.

In things that affect your health, I don't want to be the guinea pig that discovers the service I paid for wasn't up to standard. That provider may go bust in the long run, but in the meantime will do a lot of damage.

[ZeroGravitas]

If fossil fueled cars burning leaded fuel on state funded roads and then getting bailed out not that long ago is your idea of free enterprise triumphing over the state, you might not be as capitalist as you think you are.

"Bob Lutz compares Tesla to socialism after GM took $11B from taxpayers under his reign"

https://electrek.co/2016/08/18/bob-lutz-compares-tesla-socia...

I agree that cars are much better than they were 10 years ago. Thanks mostly to government regulations that the incumbent industry fought strongly, while Chinese state owned firms were taking advantage of the opportunity.

[robertlagrant]

> on state funded roads

Roads aren't cars? I'm not saying that central planning is never a good idea, just that it's mostly not a good idea. "Where to put roads that a private company will build" is a reasonable role of government in a capitalist society.

> and then getting bailed out

I don't think they should've been bailed out. That was politicians buying car worker votes by doing politician things, like inflating the currency to make everyone's wages worth less.

Cars are better not mostly because of regulations, but because of manufacturing improvements, electronic/chip hardware and software improvements, and, most of all, competition.

[pharmakom]

This makes me wonder… if Conservative strategy is to run it into the ground and then privatise, which is an unpopular plan with the public, then how are they able to consistently win elections?

[solar-ice]

Largely because the Tories are also willing to be fairly openly xenophobic, which is very popular with a large portion of the public. "Making sure the poors don't take more than they deserve" is another one of their popular policies.

The more-well-off also think Tory policies will get them a house and security. In practice, the UK housing market is completely fucked and gets more so every year, but... it doesn't stop people believing it.

Basically the health of the NHS is about the tenth thing on some people's minds when voting, until they get cancer or break an arm, at which point they start complaining about it.

[etc-hosts]

Probably because the opposition party has poor leadership and most UK newspapers are aligned with the Tories.

[ayngg]

It is more nuanced than that. The issue is that a lot of western societies are falling into debt traps because of a lot of social and economic factors which are already straining these systems to the point that they cant keep up, and the conservative strategy (in my good faith interpretation) regarding this is reducing the cost of programs that they consider to be bloated. This can be interpreted as running it into the ground as the bloat is often in bureaucracy which can easily pass the buck to actual service providers which then suffer from lack of funding. In contrast a more liberal solution would likely involve increasing spending then trying to recover that through additional taxes, which conservatives would say doesn't solve the cost problem but rather exacerbates it since bloat remains and is paid for by more debt or taxes. Of course this is just a general simplification of the conflict.

Clearly the solution is probably somewhere in between, but political polarization has simply pushed people to their party lines and entrenched their positions such that no real progress can happen while things continue to fall apart.

[starkd]

It is the organizing structure that is more efficient. It's not perfect, but just more resonspive to changes over time.

[ajross]

NHS and Medicare have historically had both very efficient allocation of resources and excellent health outcomes. This NHS argument is about new data that to me seems impossible to deconflate with a global pandemic.

Basically, libertarians are just wrong on this. Government-run health care works great and we have many decades of evidence showing that.

[pclmulqdq]

This is the first time I have ever heard of Medicare being held up as efficient. Medicare is 13% of the US government budget. More federal money goes to Medicare than to the Department of Defense. In contrast, the care that people get from Medicare is substantially worse than what you get from private insurance in the US.

[ajross]

> Medicare is 13% of the US government budget. More federal money goes to Medicare than to the Department of Defense.

These are not measures of efficiency. Medicare outlays are about 30-40% of private insurance for the same demographics.

> the care that people get from Medicare is substantially worse than what you get from private insurance

And this is, in fact, not true at all. US citizens on medicare beat their cohorts not only vs. other nations but vs. private insurance in the US too. Don't make the mistake of comparing your corporate insurance for a workforce with a median age of 30 with what retirees in the private market have available.

[pclmulqdq]

There is no doubt that Medicare has the bargaining power to drive down hospital costs compared to private insurance: Medicare gets 10c/$1 on the chargemaster at hospitals (and hospitals set prices so that Medicare's payment rate has a small profit), while private insurance tends to be able to negotiate 15-20c/$1. Individuals who are good negotiators can reportedly end up paying only 20-30c/$1, so if you have a big hospital bill, it can pay to call them up and negotiate.

Retirees on the private market get completely shafted, though: almost everybody in their age group uses medicare, so the insurance will need very high premiums to cover their risks. From what I have heard, people who are on employer plans at that age have better health outcomes than retirees, regardless of where the retiree gets their healthcare.

[amusedcyclist]

Libertarians are generally more interested in ideology than policy research

[creato]

> In contrast, the care that people get from Medicare is substantially worse than what you get from private insurance in the US.

I don’t think they are comparable. Medicare exists because private insurers refuse to cover old people at a reasonable price. It’s a good scam the private insurers have going: take peoples money when they are generally healthy and productive, drop them like a sack of shit onto the government’s lap when they aren’t.

[pclmulqdq]

The price of elder care in the US is not due to insurance companies, but due to the amount of attention someone demands before them die in a US hospital. Many socialized healthcare systems do not allow doctors to waste nearly as many resources this way.

That is why the life expectancy of the average obese, unhealthy American is about the same as the life expectancy of the average (much healthier) Japanese or European person. Americans are allowed to eat their way to an early grave and then have medical resources thrown at them to desperately keep them alive a few days longer.

EDIT: Also, I should point out that doctors generally demand a lot less end-of-life care than members of the general US population. They seem to understand that it is merely prolonging the inevitable rather than helping.