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NHS chiefs warn that hospitals in England are on the brink of collapse

Renae

Renae

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[FONT=&quot]The body that represents hospitals across England has issued a startling warning that the [/FONT]NHS[FONT=&quot] is close to breaking point because of its escalating cash crisis.
[/FONT][FONT=&quot]Years of underfunding have left the service facing such “impossible” demands that without urgent extra investment in November’s autumn statement it will have to cut staff, bring in charges or introduce “draconian rationing” of treatment – all options that will provoke public disquiet, it says
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[/FONT][FONT=&quot]“Ministers refer to ‘£10bn extra’, which to many people will seem a lot of money. But that £10bn is being stretched in a number of directions, including to pay for the seven-day NHS. Everyone who has looked into the finances of both the NHS and care system knows that this is nowhere near enough. We are the world’s fifth or sixth largest economy so it’s really horrendous that, despite our relative wealth, we have a health and social care system that is on its knees,” he added.[/FONT][FONT=&quot]
[/FONT]https://www.theguardian.com/society/2016/sep/10/hospitals-on-brink-of-collapse-say-health-chiefs[FONT=&quot]
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Always it is, that Government doesn't spend enough... /smh
 
As the population grows, wages rise, and operational costs mount, governmental services require extra funding - shocking, isn't it?
 
Renae said:
Always it is, that Government doesn't spend enough... /smh
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Because they rarely do. I think to the vast majority of Brits, the NHS is government spending priority #1 and , as usual, the Conservatives are starving it of cash, running down services and then hiving them off to the private sector.
 
Renae said:
Always it is, that Government doesn't spend enough... /smh
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Nope, it social medicine. Providing an essentially private good publicly always faces the danger of the Tragedy of the Commons. You learn that much in the first semester of economics. The reality of health care and its finance is more complicated, of course. But the principle is solid and any number of social democratic babble and programs of continuously growing complexity to obfuscate their fiasco will not make the truth of the matter go away.
 
The reality is that the previous government targeted public services, and the NHS in particular, under their "austerity" policy deliberately underfunding below inflation while demaning more. The new/old May regime is continuing the process. half of them have positions with private healthcare companies, and almost all previous health ministers, of all parties.

CsJLAnLWIAAzdUo.jpg:large


The HSCA required among other things, that health "purchasers" (Clinical Commissioning Groups) favour private sector providers of services.

So Branson's "Virgin Care" provides your local health centre and it's employees under the NHS logo, funded by taxation.
 
joG said:
Nope, it social medicine. Providing an essentially private good publicly always faces the danger of the Tragedy of the Commons. You learn that much in the first semester of economics. The reality of health care and its finance is more complicated, of course. But the principle is solid and any number of social democratic babble and programs of continuously growing complexity to obfuscate their fiasco will not make the truth of the matter go away.
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The Tragedy of Commons is an issue with healthcare regardless of how it is funded, it just have different consequences in different environments. In a fully individually-funded system, the price of healthcare would quickly be lifted out of the reach of many people which is why places where the core system is privately-funded still require significant state-funded “safety nets” (the US being the obvious example).
 
HonestJoe said:
The Tragedy of Commons is an issue with healthcare regardless of how it is funded, it just have different consequences in different environments. In a fully individually-funded system, the price of healthcare would quickly be lifted out of the reach of many people which is why places where the core system is privately-funded still require significant state-funded “safety nets” (the US being the obvious example).
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It is not that simple. Some health care is expensive and out of the reach of all but those willing to pay for it in any event. The difficulty is apportioning it. If all is made available to all, the system will require higher payments than any economy can maintain. So let's drop the false path of argumentation. It is one that the social democrats have always loved, because it motivates envy and the desire for free lunches. But the result is clearly visible in systems that try to produce private goods publicly. The real tragedy here is that voters are led to believe by politicians and bureaucrats looking to justify their jobs that they will participate in first rate medicine that they then do not get, which they find out much later, when they can no longer choose privat insurance.

PS: The US chose a similarly idiotic system by which citizens could stay uninsured till they entered more or less public medical services, when they reach a given age.
 
joG said:
It is not that simple.
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Exactly, that’s why I was challenging your simple statement that “It’s social medicine.”. Modern healthcare is complicated and no underlying model for it, be it entirely social healthcare, entirely private provision or some mixture of the two, is fundamentally bad or fundamentally good. The current problems with the NHS obviously involves it’s underlying structure but then the problems that all Western countries healthcare systems have involve their different underlying structure. Changing those structures, regardless of the direction they might be changes to, won’t end their problems, only shift them. The core causes remain the same – ageing and less healthy populations, every increasing expectations, constantly developing medical science and general economic problems.
 
HonestJoe said:
Exactly, that’s why I was challenging your simple statement that “It’s social medicine.”. Modern healthcare is complicated and no underlying model for it, be it entirely social healthcare, entirely private provision or some mixture of the two, is fundamentally bad or fundamentally good. The current problems with the NHS obviously involves it’s underlying structure but then the problems that all Western countries healthcare systems have involve their different underlying structure. Changing those structures, regardless of the direction they might be changes to, won’t end their problems, only shift them. The core causes remain the same – ageing and less healthy populations, every increasing expectations, constantly developing medical science and general economic problems.
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That is why I spent so much time working my way through the German system. But it terns out that besides all the details and in spite of all the attempted corrections by a slew of regulation upon new regulation over two decades the thing boils down to the fact that a private good should not be supplied by the public.

The way to go is simple regulation of a private sector for health insurance insurance and separately health care. Beyond that it should be left to the individual to choose her policies.
 
joG said:
… the thing boils down to the fact that a private good should not be supplied by the public.
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So you keep saying but I don’t think anything here actually supports that position. It strikes me that you have a fixed point of principle and are looking for reasons to hold to it rather than the other (correct) way around.

joG said:
The way to go is simple regulation of a private sector for health insurance insurance and separately health care. Beyond that it should be left to the individual to choose her policies.
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You can’t choose any insurance policy if you don’t have any money. That’s certainly a possible system but it’s in no way a solution to all the problems of modern healthcare and there’s nothing about it that automatically makes it better than any alternative system. If there was a simple magic answer to all our problems, we’d all be using it already.
 
HonestJoe said:
1. So you keep saying but I don’t think anything here actually supports that position. It strikes me that you have a fixed point of principle and are looking for reasons to hold to it rather than the other (correct) way around.

2. You can’t choose any insurance policy if you don’t have any money. That’s certainly a possible system but it’s in no way a solution to all the problems of modern healthcare and there’s nothing about it that automatically makes it better than any alternative system. If there was a simple magic answer to all our problems, we’d all be using it already.
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1. Not at all a "fixed principal". Just a fundamental piece of economics. And yes, I have looked at the real world and found the theory to be correct.

2. If we are talking about persons that do not have smart phones and place to sleep, say with an income under 10.000 a year, then we are talking about a totally different thing than public health care. You are then talking poverty and how to treat it. So keep your arguments clean and don't let other issues confuse you.
 
joG said:
1. Not at all a "fixed principal". Just a fundamental piece of economics. And yes, I have looked at the real world and found the theory to be correct.
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I'm sure you believe so. As I said though, nothing presented here supports your hypothesis. I'm not even convinced it's possible to support the idea that "no private good should be provided by the public" with an example of only one kind of "private good".

joG said:
2. If we are talking about persons that do not have smart phones and place to sleep, say with an income under 10.000 a year, then we are talking about a totally different thing than public health care. You are then talking poverty and how to treat it. So keep your arguments clean and don't let other issues confuse you.
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Poverty is relative so there will always be a significant proportion of the population who can't afford health insurance in a free market. I'm not aware of any modern system that doesn't have some form of state support or provision for the poor and I don't see how any system could would without something along those lines.
 
HonestJoe said:
1. I'm sure you believe so. As I said though, nothing presented here supports your hypothesis. I'm not even convinced it's possible to support the idea that "no private good should be provided by the public" with an example of only one kind of "private good".

2. Poverty is relative so there will always be a significant proportion of the population who can't afford health insurance in a free market. I'm not aware of any modern system that doesn't have some form of state support or provision for the poor and I don't see how any system could would without something along those lines.
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1. I can only advise you look up "public good" and acquaint yourself with the difference between public and private goods. Wikipedia has a relatively short article, which as a general info is quite okay. After that we can discuss the reasons that speak for or against different health care aspects belonging to the "public" category or not.

2. But you are talking a totally different subject in economic terms, when you sight health insurance and poverty support. Though, one might e required to allow the other to be paid for, we are not talking public health care any more but the level of income one wants to give the poor.
 
joG said:
1. I can only advise you look up "public good" and acquaint yourself with the difference between public and private goods.
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That’s not the problem I have. You’ve asserted a general principle; that “no private good should be provided by the public”. If you’re going to apply that principle to automatically invalidate the concept of and any all public healthcare, you first need to establish that the general principle is correct and unconditional. All of that is before we even get to the question of where the various elements of healthcare fall on this public/private good line.

joG said:
2. But you are talking a totally different subject in economic terms, when you sight health insurance and poverty support. Though, one might e required to allow the other to be paid for, we are not talking public health care any more but the level of income one wants to give the poor.
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I’ve not said anything about giving income to the poor. We’re talking about establishing an effective healthcare system and one aspect of it being effective is it being access and availability (at least to a certainly level). Universal healthcare is beneficial to the health of everyone since the poor health of others can impact everyone else’s.

If you’re proposing a form of healthcare system that has any kind of barrier to access, be that financial, geographic, cultural etc., to establish an effective universal healthcare system, you need to somehow account for those people who can’t naturally overcome those barriers. You can’t claim to be proposing a valid system if you don’t at least acknowledge that. A healthcare system based entirely on private provision for payment (be that direct or via insurance) has to account for people who can’t simply afford to make those payments in some way or other. That accounting could be “tough luck” and dealing with the consequences but you still have to state that and accept it in assessments of the pros and cons of that proposed system.

Fully publically funding systems have to answer their own questions too – issues like overall funding, practical limitations to the service and the Tragedy of Commons you mentioned earlier. Plenty of people propose fantasy public healthcare systems that don’t take any of those realities in to account. As I’ve said, there is a very good reason why pretty much every healthcare system in the Western world actually involves some combination of public and private involvement. In practical terms, I don’t think you can say “never” to either of them.
 
HonestJoe said:
That’s not the problem I have. You’ve asserted a general principle; that “no private good should be provided by the public”. If you’re going to apply that principle to automatically invalidate the concept of and any all public healthcare, you first need to establish that the general principle is correct and unconditional. All of that is before we even get to the question of where the various elements of healthcare fall on this public/private good line.
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That IS the question. Where is it written that public funds may not be used to provide private goods? It's an opinion, nothing more.
 
great back and forth in this thread.


The one thing I damn for sure dont want to see is the use of any funding issues in the health services being used against the citizens right to eat and drink what they like generally. I see too many dictates from the top that way too often come along with "there has got to be a way to force the people to do act according to our will".
 
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Hawkeye10 said:
great back and forth in this thread.


The one thing I damn for sure dont want to see is the use of any funding issues in the health services being used against the citizens right to eat and drink what they like generally. I see too many dictates from the top that way too often come along with "there has got to be a way to force the people to do act according to our will".
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Exactly.

The publicly funded healthcare system, short of money and long on demand and expectations (pretty much like every other government program) will start to ration healthcare treatment, will impose long waiting lists (hoping patients get fed up and / or die waiting), and will also impose life style / life choices penalties.

"Why should we cover you when you are an avid skydiving enthusiast?" (motorcycle / civilian aircraft / ... [fill in risky behavior here] ).
"Why should we cover you when you like to eat pizza so often?" (beef / hamburgers / cold cuts / sugery soda / ... [fill in risky food choice here] )
(Recall that Bloomberg wanted a 'soda tax' - so not too hard to image it coming to pass)

(
Just wait until the climate warming guys figure out that methane is 20 times the green house gas that CO2 is, and it's greatest source is cows. They'll demand that everyone become a vegan.
)

There'll always be someone there that'll agree and support the government's decision because it doesn't affect them this instance.

Should there come a time when the government decides against them, then it'll be the sky is falling and 'they can't do that'. Typical. Oh so typical.
 
Gaztopian said:
As the population grows, wages rise, and operational costs mount, governmental services require extra funding - shocking, isn't it?
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Did you realize, I was talking with a Brit the other day, he said that NHS wouldn't pay his implants. Poor guy. 'says that steaks don't taste like they used to. No satisfaction anymore. ;)
 
HonestJoe said:
That’s not the problem I have. You’ve asserted a general principle; that “no private good should be provided by the public”. If you’re going to apply that principle to automatically invalidate the concept of and any all public healthcare, you first need to establish that the general principle is correct and unconditional. All of that is before we even get to the question of where the various elements of healthcare fall on this public/private good line.

I’ve not said anything about giving income to the poor. We’re talking about establishing an effective healthcare system and one aspect of it being effective is it being access and availability (at least to a certainly level). Universal healthcare is beneficial to the health of everyone since the poor health of others can impact everyone else’s.

If you’re proposing a form of healthcare system that has any kind of barrier to access, be that financial, geographic, cultural etc., to establish an effective universal healthcare system, you need to somehow account for those people who can’t naturally overcome those barriers. You can’t claim to be proposing a valid system if you don’t at least acknowledge that. A healthcare system based entirely on private provision for payment (be that direct or via insurance) has to account for people who can’t simply afford to make those payments in some way or other. That accounting could be “tough luck” and dealing with the consequences but you still have to state that and accept it in assessments of the pros and cons of that proposed system.

Fully publically funding systems have to answer their own questions too – issues like overall funding, practical limitations to the service and the Tragedy of Commons you mentioned earlier. Plenty of people propose fantasy public healthcare systems that don’t take any of those realities in to account. As I’ve said, there is a very good reason why pretty much every healthcare system in the Western world actually involves some combination of public and private involvement. In practical terms, I don’t think you can say “never” to either of them.
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1. You misquoted me by leaving the main part out, which was: "After that we can discuss the reasons that speak for or against different health care aspects belonging to the "public" category or not." You see, you do have a problem with: "That’s not the problem I have." And there is no point in discussing the topic further as long as you say: "You’ve asserted a general principle; that “no private good should be provided by the public”. If you’re going to apply that principle to automatically invalidate the concept of and any all public healthcare, you first need to establish that the general principle is correct and unconditional. All of that is before we even get to the question of where the various elements of healthcare fall on this public/private good line."

2. "I’ve not said anything about giving income to the poor." Is the problem. You should have. Instead you were arguing public health care with people being poor. In other words, you were mixing two completly different problems and so coming to false arguments.
As I pointed out under 1., you must first know, what a public good is and why it reduces general welfare, when government supplies it. Then please think about what it means to mix one's arguments without any reason to.
 
Andalublue said:
That IS the question. Where is it written that public funds may not be used to provide private goods? It's an opinion, nothing more.
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Well, it is an opinion. That much is right. The thing is that it is like the opinion that water freezes at zero degrees Centigrade. It must not be correct under certain conditions, but it is a well tested science based place to start a discussion about the freezing point of water. On the other hand, it is uneducated to start by saying that water freezes at a higher temperature and the zero degree hypothesis is only an opinion.
 
joG said:
As I pointed out under 1., you must first know, what a public good is and why it reduces general welfare, when government supplies it.
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If that’s the assertion you’re making, you need to explain and support it. As things stand, I've not been convinced that government providing public goods is automatically and unconditionally a bad thing.

As it happens, I also think healthcare falls on a fuzzy line between public good and private good that means it really needs to be considered on its own merits rather than on the basis of such wider economic principles anyway.
 
cpwill said:
Where is the tragedy of the commons in healthcare?
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Good question. To see it, we would have to abstract the problem and think about the funds available for health care as limited. This assumption can be relaxed in a later step, if one wants. If there is a certain sum that can be paid, then investments in facilities, equipment and personell will be made accordingly. Since it costs the consumer nothing (or much less than the actual costs to government paying the bill) people will tend to use more of it just like the farmers in the original Tragedy. As the funds are capped the overuse means that wear and tear will be high, nerves will be fraught and the care that is offered will fall in quality and/or be less available. This has happened in Germany, where people pay about 15 Percent (average of the public insurances) of their wages into the health care system. Hygiene fell, incidence of MRSA exploded, to few nurses and doctors can be employed, specialists are rationed, hospitals a have been closed etc etc.

We said the limit on available funds can be increased. This happened in Germany and the population got restive, as the portion of earned income had to be increased. So the service quality and levels were again modified down with some rationing on availability of procedures etc and the portion of income is now back around 14.6 percent again. If something is free to the consumer then it will be overused.
 
HonestJoe said:
If that’s the assertion you’re making, you need to explain and support it. As things stand, I've not been convinced that government providing public goods is automatically and unconditionally a bad thing.

As it happens, I also think healthcare falls on a fuzzy line between public good and private good that means it really needs to be considered on its own merits rather than on the basis of such wider economic principles anyway.
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I think I pointed out there is a relatively easy to read explanation in Wikipedia on "public good". It is a standard term and the easiest way to understand it is to read it in a standard text like the one I mentioned. But let me link it, though, it is usually a sign of disinterest, when one has to link Wikipedia entries.
0. https://en.wikipedia.org/wiki/Free_rider_problem *)
1. https://en.wikipedia.org/wiki/Good_(economics)
2. https://en.wikipedia.org/wiki/Private_good
3. https://en.wikipedia.org/wiki/Public_good

*) The "free rider problem" is an important reason for not distributing private goods publicly as the price mechanism does not work so that production and allocation will be sub-optimal.
 
joG said:
I think I pointed out there is a relatively easy to read explanation in Wikipedia on "public good...
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I understand the terminology and I understand the various problems relating to them. I’m questioning your assertion that these problems mean that no private good should ever supplied by the public and the extended implication that any level of government healthcare is automatically and unconditionally a bad thing.
 
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