[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.