Erosion of the NHS

[Son of Mathonwy]

The NHS is being pushed towards privatisation and away from universal provision of care. It's a complex matter (which will probably keep it out of the headlines), but this is worth reading closely:

https://www.theguardian.com/commentisfr ... vatisation

Linked in the piece is the more detailed proposal by the authors:
https://bills.parliament.uk/publication ... uments/662

Labour needs to be all over this and ring alarm bells.

[Which Tyler]

We're at least 10 years into the erosion

[Son of Mathonwy]

We're at least 10 years into the erosion

Yeah, no denying that but this is the next big step in the process.

[Sandydragon]

It feels like we are long overdue a proper review of what the NHS does (and doesn't) do and how its funded. But no one seems to have the appetite for that so we get this drip, drip, drip of tactical change which may or may not align with what's actually best for the country.

[Son of Mathonwy]

It feels like we are long overdue a proper review of what the NHS does (and doesn't) do and how its funded. But no one seems to have the appetite for that so we get this drip, drip, drip of tactical change which may or may not align with what's actually best for the country.

They're not interested in a review, consultation or debate on the NHS because they're not interested in what anyone else (particularly the general public) thinks. They're just getting on with the job of remodelling our Health Service on one of the most inefficient and inequitable in the developed world.

[padprop]

It feels like we are long overdue a proper review of what the NHS does (and doesn't) do and how its funded. But no one seems to have the appetite for that so we get this drip, drip, drip of tactical change which may or may not align with what's actually best for the country.

They're not interested in a review, consultation or debate on the NHS because they're not interested in what anyone else (particularly the general public) thinks. They're just getting on with the job of remodelling our Health Service on one of the most inefficient and inequitable in the developed world.

Because it would be political suicide to outright say that the NHS model may be outdated and all care completely at the point of demand may not be the best model for the best overall health outcomes. Most top 10 performing healthcare systems in the world have a heavily subsided healthcare model with a social safety net for those unable to afford it, but payments by those who can. However, suggesting anything akin to this would result in terrible outcomes for the party in power, even if theoretically it would lead to better outcomes to the country at large.

[Son of Mathonwy]

It feels like we are long overdue a proper review of what the NHS does (and doesn't) do and how its funded. But no one seems to have the appetite for that so we get this drip, drip, drip of tactical change which may or may not align with what's actually best for the country.

They're not interested in a review, consultation or debate on the NHS because they're not interested in what anyone else (particularly the general public) thinks. They're just getting on with the job of remodelling our Health Service on one of the most inefficient and inequitable in the developed world.

Because it would be political suicide to outright say that the NHS model may be outdated and all care completely at the point of demand may not be the best model for the best overall health outcomes. Most top 10 performing healthcare systems in the world have a heavily subsided healthcare model with a social safety net for those unable to afford it, but payments by those who can. However, suggesting anything akin to this would result in terrible outcomes for the party in power, even if theoretically it would lead to better outcomes to the country at large.

You may not like the UK system but please don't argue that it needs to be changed because it's 'outdated'. Its age is irrelevant.
Why would a change from a system that is free at point of demand 'theoretically' 'lead to better outcomes to the country at large'?

[padprop]

They're not interested in a review, consultation or debate on the NHS because they're not interested in what anyone else (particularly the general public) thinks. They're just getting on with the job of remodelling our Health Service on one of the most inefficient and inequitable in the developed world.

Because it would be political suicide to outright say that the NHS model may be outdated and all care completely at the point of demand may not be the best model for the best overall health outcomes. Most top 10 performing healthcare systems in the world have a heavily subsided healthcare model with a social safety net for those unable to afford it, but payments by those who can. However, suggesting anything akin to this would result in terrible outcomes for the party in power, even if theoretically it would lead to better outcomes to the country at large.

You may not like the UK system but please don't argue that it needs to be changed because it's 'outdated'. Its age is irrelevant.
Why would a change from a system that is free at point of demand 'theoretically' 'lead to better outcomes to the country at large'?

I don’t dislike the structure of the NHS, its a far cry from the some of the worser performing first-world country health systems and as a country we are hugely lucky to have it.

Irregardless, a lack of incentives inherently leads to more capital waste and less patients treated. This was less of an issue in the 1950s when there was very little hospital bed pressure due to a younger average population and less chronic disease. Government spending on the NHS has increased 10 fold in real terms since its inception in 1950s to 2020. When I say outdated that is what I am referring to. It is impossible that the NHS could have foresaw such a massive change.

While there is an incentive structure in the NHS between trusts, with better trusts being financially rewarded, this does not translate to boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency.

“Theoretically,” this would lead to better health outcomes. If the public had a degree of choice for their healthcare provider (with a qualifier that these should always be truly affordable) and there was competition between these providers, you would expect prices to be driven down, more efficiency and better outcomes for the general population. As stated before, there should always be a social safety net for those who would be unable to make such a choice.

Would that solve all the problems? Not at all. The only true way out of rapidly ageing first-world countries is likely AI and robotic medicine, something that is being heavily invested in in both China and Japan.

[Son of Mathonwy]

Because it would be political suicide to outright say that the NHS model may be outdated and all care completely at the point of demand may not be the best model for the best overall health outcomes. Most top 10 performing healthcare systems in the world have a heavily subsided healthcare model with a social safety net for those unable to afford it, but payments by those who can. However, suggesting anything akin to this would result in terrible outcomes for the party in power, even if theoretically it would lead to better outcomes to the country at large.

You may not like the UK system but please don't argue that it needs to be changed because it's 'outdated'. Its age is irrelevant.
Why would a change from a system that is free at point of demand 'theoretically' 'lead to better outcomes to the country at large'?

I don’t dislike the structure of the NHS, its a far cry from the some of the worser performing first-world country health systems and as a country we are hugely lucky to have it.

Irregardless, a lack of incentives inherently leads to more capital waste and less patients treated. This was less of an issue in the 1950s when there was very little hospital bed pressure due to a younger average population and less chronic disease. Government spending on the NHS has increased 10 fold in real terms since its inception in 1950s to 2020. When I say outdated that is what I am referring to. It is impossible that the NHS could have foresaw such a massive change.

While there is an incentive structure in the NHS between trusts, with better trusts being financially rewarded, this does not translate to boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency.

“Theoretically,” this would lead to better health outcomes. If the public had a degree of choice for their healthcare provider (with a qualifier that these should always be truly affordable) and there was competition between these providers, you would expect prices to be driven down, more efficiency and better outcomes for the general population. As stated before, there should always be a social safety net for those who would be unable to make such a choice.

Would that solve all the problems? Not at all. The only true way out of rapidly ageing first-world countries is likely AI and robotic medicine, something that is being heavily invested in in both China and Japan.

Okay, I can see where you're coming from on this. I used to think some of those things too (when I subscribed to the Economist).

First up, the NHS is a world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed.
https://ceoworld.biz/2021/04/27/reveale ... tems-2021/

Next, you are talking about two separate things: 1) healthcare that is paid for directly by the patient (albeit with a safety net for the poor) and 2) healthcare provided by a collection of competing private healthcare companies. And then you argue that because 2) has some theoretical efficiencies then we should change to a system including 1). But 1) and 2) do not need to go together: a system could include either, neither or both of these features (eg a system could be paid for as the NHS but have GPs choosing the most appropriate private healthcare systems for the patients). So your argument doesn't make the case for 1).

Re your argument for the theoretical advantages of competing private healthcare companies: sure, this is the neoliberal orthodox view, but there are many significant disadvantages:

You'd have a system where there'd be a number of companies, each providing a wide range of health services. As such they'd need to be quite large and so they'd be quite limited in number, so you'd naturally get an oligopoly, dominance by a small number of large entities, which would limit efficiency gains since the situation would be a long way from perfect competition. Most of the 'consumers' of the 'product' are not well informed on the details of medicine, and so would mostly select healthcare based on advertising (that's where they'd actually get a choice and not simply be forced to use the service their employer subscribes them to). Marketing and advertising are not needed by the NHS and so they are an extra inefficiency of the private system. As the entities would be smaller than the NHS, they would be unlikely to have its breadth of expertise. As they are driven by profit they would be uninterested in treating conditions which have high costs. Dividend payments to shareholders do not exist in the NHS model, so are an extra inefficiency of the private system. The primary concern of private companies is profit maximisation not medical excellence: so they would deliver healthcare which meets the minimum they are contracted to deliver, and no more. Also, if the have any access or influence over the decision-making process, they will (for the same reason) seek solutions which maximise profit, rather than the best medical outcomes. If differing levels of medical cover exist in the system, time and effort will be needed to determine which form of care the patient qualifies for - another inefficiency of the system.

These are some of the problems which private companies bring which need to be considered along with efficiency advantages due to competition. However, in the field of healthcare there is the more fundamental issue which may or may not trouble you, depending on your views on equality. My view is that health is something we all have an equal right to, regardless of wealth (or any other factor), and so, unless strict uniformity of product is regulated and maintained, a private system will fall short. And if the private system is allowed to have explicitly different levels of cover (which would presumably be lower for those with the least wealth), then equality of health will be history. That's unacceptable (to me), in a way that it's not in other areas - eg I don't mind if someone has a more expensive car than someone else. That's why I'm more comfortable with a capitalist approach in many (but not all) areas outside of health.

Finally, re your thinking on a lack of incentive for 'boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency'. I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride. (That was even true in the City, which is my background. You choose that line of work at least partly because of the money. But on a day-to-day basis you do good work because of professional pride and team spirit.)

[morepork]

I you hand over health to insurance companies, you'll never get it back. That kind of market driven philosophy fell flat on its arse when a functioning health system was needed the most.

[Puja]

You may not like the UK system but please don't argue that it needs to be changed because it's 'outdated'. Its age is irrelevant.
Why would a change from a system that is free at point of demand 'theoretically' 'lead to better outcomes to the country at large'?

I don’t dislike the structure of the NHS, its a far cry from the some of the worser performing first-world country health systems and as a country we are hugely lucky to have it.

Irregardless, a lack of incentives inherently leads to more capital waste and less patients treated. This was less of an issue in the 1950s when there was very little hospital bed pressure due to a younger average population and less chronic disease. Government spending on the NHS has increased 10 fold in real terms since its inception in 1950s to 2020. When I say outdated that is what I am referring to. It is impossible that the NHS could have foresaw such a massive change.

While there is an incentive structure in the NHS between trusts, with better trusts being financially rewarded, this does not translate to boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency.

“Theoretically,” this would lead to better health outcomes. If the public had a degree of choice for their healthcare provider (with a qualifier that these should always be truly affordable) and there was competition between these providers, you would expect prices to be driven down, more efficiency and better outcomes for the general population. As stated before, there should always be a social safety net for those who would be unable to make such a choice.

Would that solve all the problems? Not at all. The only true way out of rapidly ageing first-world countries is likely AI and robotic medicine, something that is being heavily invested in in both China and Japan.

Okay, I can see where you're coming from on this. I used to think some of those things too (when I subscribed to the Economist).

First up, the NHS is a world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed.
https://ceoworld.biz/2021/04/27/reveale ... tems-2021/

Next, you are talking about two separate things: 1) healthcare that is paid for directly by the patient (albeit with a safety net for the poor) and 2) healthcare provided by a collection of competing private healthcare companies. And then you argue that because 2) has some theoretical efficiencies then we should change to a system including 1). But 1) and 2) do not need to go together: a system could include either, neither or both of these features (eg a system could be paid for as the NHS but have GPs choosing the most appropriate private healthcare systems for the patients). So your argument doesn't make the case for 1).

Re your argument for the theoretical advantages of competing private healthcare companies: sure, this is the neoliberal orthodox view, but there are many significant disadvantages:

You'd have a system where there'd be a number of companies, each providing a wide range of health services. As such they'd need to be quite large and so they'd be quite limited in number, so you'd naturally get an oligopoly, dominance by a small number of large entities, which would limit efficiency gains since the situation would be a long way from perfect competition. Most of the 'consumers' of the 'product' are not well informed on the details of medicine, and so would mostly select healthcare based on advertising (that's where they'd actually get a choice and not simply be forced to use the service their employer subscribes them to). Marketing and advertising are not needed by the NHS and so they are an extra inefficiency of the private system. As the entities would be smaller than the NHS, they would be unlikely to have its breadth of expertise. As they are driven by profit they would be uninterested in treating conditions which have high costs. Dividend payments to shareholders do not exist in the NHS model, so are an extra inefficiency of the private system. The primary concern of private companies is profit maximisation not medical excellence: so they would deliver healthcare which meets the minimum they are contracted to deliver, and no more. Also, if the have any access or influence over the decision-making process, they will (for the same reason) seek solutions which maximise profit, rather than the best medical outcomes. If differing levels of medical cover exist in the system, time and effort will be needed to determine which form of care the patient qualifies for - another inefficiency of the system.

These are some of the problems which private companies bring which need to be considered along with efficiency advantages due to competition. However, in the field of healthcare there is the more fundamental issue which may or may not trouble you, depending on your views on equality. My view is that health is something we all have an equal right to, regardless of wealth (or any other factor), and so, unless strict uniformity of product is regulated and maintained, a private system will fall short. And if the private system is allowed to have explicitly different levels of cover (which would presumably be lower for those with the least wealth), then equality of health will be history. That's unacceptable (to me), in a way that it's not in other areas - eg I don't mind if someone has a more expensive car than someone else. That's why I'm more comfortable with a capitalist approach in many (but not all) areas outside of health.

Finally, re your thinking on a lack of incentive for 'boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency'. I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride. (That was even true in the City, which is my background. You choose that line of work at least partly because of the money. But on a day-to-day basis you do good work because of professional pride and team spirit.)

<claps>

Not to mention that the NHS gets excellent deals on drug prices and equipment because it's acting as a monopoly to pharmaceutical companies wanting to provide prescription medicine in the UK. A perfect example of why a free competitive market isn't a universal panacea that automatically reaches the most efficient result.

Puja

[cashead]

What sort of fucking brainworms do you need in order to look at the for-profit healthcare system in the US and think "hmm, yes, that is indeed the model that we must emulate."

[Which Tyler]

What sort of fucking brainworms do you need in order to look at the for-profit healthcare system in the US and think "hmm, yes, that is indeed the model that we must emulate."

well, being owned by board members of the insurance companies kinda helps

[Puja]

What sort of fucking brainworms do you need in order to look at the for-profit healthcare system in the US and think "hmm, yes, that is indeed the model that we must emulate."

People with a shit tonne of money for whom a system of "more money = better care" works out quite nicely, and who have investments in private medical companies.

Puja

[padprop]

You may not like the UK system but please don't argue that it needs to be changed because it's 'outdated'. Its age is irrelevant.
Why would a change from a system that is free at point of demand 'theoretically' 'lead to better outcomes to the country at large'?

I don’t dislike the structure of the NHS, its a far cry from the some of the worser performing first-world country health systems and as a country we are hugely lucky to have it.

Irregardless, a lack of incentives inherently leads to more capital waste and less patients treated. This was less of an issue in the 1950s when there was very little hospital bed pressure due to a younger average population and less chronic disease. Government spending on the NHS has increased 10 fold in real terms since its inception in 1950s to 2020. When I say outdated that is what I am referring to. It is impossible that the NHS could have foresaw such a massive change.

While there is an incentive structure in the NHS between trusts, with better trusts being financially rewarded, this does not translate to boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency.

“Theoretically,” this would lead to better health outcomes. If the public had a degree of choice for their healthcare provider (with a qualifier that these should always be truly affordable) and there was competition between these providers, you would expect prices to be driven down, more efficiency and better outcomes for the general population. As stated before, there should always be a social safety net for those who would be unable to make such a choice.

Would that solve all the problems? Not at all. The only true way out of rapidly ageing first-world countries is likely AI and robotic medicine, something that is being heavily invested in in both China and Japan.

Okay, I can see where you're coming from on this. I used to think some of those things too (when I subscribed to the Economist).

First up, the NHS is a world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed.
https://ceoworld.biz/2021/04/27/reveale ... tems-2021/

Next, you are talking about two separate things: 1) healthcare that is paid for directly by the patient (albeit with a safety net for the poor) and 2) healthcare provided by a collection of competing private healthcare companies. And then you argue that because 2) has some theoretical efficiencies then we should change to a system including 1). But 1) and 2) do not need to go together: a system could include either, neither or both of these features (eg a system could be paid for as the NHS but have GPs choosing the most appropriate private healthcare systems for the patients). So your argument doesn't make the case for 1).

Re your argument for the theoretical advantages of competing private healthcare companies: sure, this is the neoliberal orthodox view, but there are many significant disadvantages:

You'd have a system where there'd be a number of companies, each providing a wide range of health services. As such they'd need to be quite large and so they'd be quite limited in number, so you'd naturally get an oligopoly, dominance by a small number of large entities, which would limit efficiency gains since the situation would be a long way from perfect competition. Most of the 'consumers' of the 'product' are not well informed on the details of medicine, and so would mostly select healthcare based on advertising (that's where they'd actually get a choice and not simply be forced to use the service their employer subscribes them to). Marketing and advertising are not needed by the NHS and so they are an extra inefficiency of the private system. As the entities would be smaller than the NHS, they would be unlikely to have its breadth of expertise. As they are driven by profit they would be uninterested in treating conditions which have high costs. Dividend payments to shareholders do not exist in the NHS model, so are an extra inefficiency of the private system. The primary concern of private companies is profit maximisation not medical excellence: so they would deliver healthcare which meets the minimum they are contracted to deliver, and no more. Also, if the have any access or influence over the decision-making process, they will (for the same reason) seek solutions which maximise profit, rather than the best medical outcomes. If differing levels of medical cover exist in the system, time and effort will be needed to determine which form of care the patient qualifies for - another inefficiency of the system.

These are some of the problems which private companies bring which need to be considered along with efficiency advantages due to competition. However, in the field of healthcare there is the more fundamental issue which may or may not trouble you, depending on your views on equality. My view is that health is something we all have an equal right to, regardless of wealth (or any other factor), and so, unless strict uniformity of product is regulated and maintained, a private system will fall short. And if the private system is allowed to have explicitly different levels of cover (which would presumably be lower for those with the least wealth), then equality of health will be history. That's unacceptable (to me), in a way that it's not in other areas - eg I don't mind if someone has a more expensive car than someone else. That's why I'm more comfortable with a capitalist approach in many (but not all) areas outside of health.

Finally, re your thinking on a lack of incentive for 'boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency'. I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride. (That was even true in the City, which is my background. You choose that line of work at least partly because of the money. But on a day-to-day basis you do good work because of professional pride and team spirit.)

Good post, I agree with a lot of it. Appreciate I haven't answered all your queries but thought I'd clear up what I could.

"world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed."

Never claimed that the change had to be radical. This was my point with my initial post, any discussion of the NHS moving away from a completely free at a point of demand service is a third rail that no one can touch, and is seen as a tell that the individual wants to turn the UK into a pseudo-USA system. Dentistry already isn't free as part of the NHS, but it is heavily subsided to the point where it is affordable to almost everyone if you cannot afford private treatment.

To the best of my ability I have been attempting to describe a Japanese/ South Korean/ Australian style healthcare system. All systems that have a university healthcare safety net but those that can afford it pay health insurance. If those are deemed as being greedy free market healthcare systems that put money before patients then fair enough, my points will fall on deaf ears.

I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride.

Paying them well is an incentive. It was much simpler to pay a nurses, consultant's and registrars well when the NHS was a much smaller chunk of GDP, lesser so now with massive GP and hospital bed demand. Then it simply comes down to how you think the money should be raised to make up for this increased demand. Higher taxes? A fair option but comes with it's own issues and would not be a popular policy. Health insurance for people making over X amount? Would be a hugely unpopular policy but would free up money that may otherwise be stored away in savings. Their taxes would also be further helping to subsidise those would couldn't afford it. Of course this is all hypothetical as people would never vote for either.

As long as the government have complete control over NHS funding, then they'll cut every possible pound they can get from nurses and doctors, as wages are the biggest expenditure of healthcare. Whether its conservatives, labour or lib dems, no government is paying the NHS larger salaries out of the goodness of their heart. It's all just a game of incentives to get more people in the workforce. If doctors and nurses leave the NHS because they are feeling underpaid (Which they are in record numbers, a large chunk to australia), there will be no-one to save the patient's life. So yes, inadvertently incentives do save patient's lives. Appreciate that this is a bit of a bait and switch from my previous post where I alluded to more money for more work done but I think you are right, that in itself would not help the general population (But definitely does contribute to greater efficiency in private healthcare in the UK where more surgeries equals more money for the whole theatre team.)

TL;DR - Healthcare insurance for those that can afford it benefits the population as it leads to more money in the healthcare system for doctors, nurses and further hospital beds. This however should never be at the expense of unequal health outcomes.

I realise this is all a bit of a tangent from what this thread is all about. I dislike the cloak and dagger privatisation, but unless we have frank discussions, as SandyDragon stated, about what may be best for everyone, then the nefariousness will continue. I just think we can consider some of the healthcare tools of the few countries that are more successful than ourselves on almost every measure.

[cashead]

Taking something that should be a right, in order to create a for-profit industry is fucked up. hth.

[morepork]

Hippocratic oath made opaque by incentive is a recipe for disaster. Health care is a fundamental right and a functioning health system promotes a healthy economy/society, as the covid situation has made so brutally apparent. You shouldn't be apportioning resources for fundamentals on the basis of some obtuse market risk/benefit metric. Are we really suggesting a non-centralised non-government entity would not cut every possible corner in the interest of profit? Madness. The data is out on that experiment.

[cashead]

What sort of fucking brainworms do you need in order to look at the for-profit healthcare system in the US and think "hmm, yes, that is indeed the model that we must emulate."

well, being owned by board members of the insurance companies kinda helps

Sure, some politician, like that band of venal fuckpigs called the Cuntservative Party that your lot saw fit to vote for a couple of years ago being in the pocket of the insurance industry and acting accordingly makes sense. At least they get money out of it. It's more the people like the one earlier on here, who is insisting free market bullshit should apply to healthcare. Like, what the actual fuck? I just wonder what makes them think this shit actually works, when there's literally decades of data that shows that it demonstrably doesn't. Shit, just look at the disaster that is the American for-profit healthcare industry. Anyone who looks at that and says "ah yes, very good. Let's do that," had better be getting paid handsomely for it, because otherwise, they're out of their fucking gourd.

[Son of Mathonwy]

I don’t dislike the structure of the NHS, its a far cry from the some of the worser performing first-world country health systems and as a country we are hugely lucky to have it.

Irregardless, a lack of incentives inherently leads to more capital waste and less patients treated. This was less of an issue in the 1950s when there was very little hospital bed pressure due to a younger average population and less chronic disease. Government spending on the NHS has increased 10 fold in real terms since its inception in 1950s to 2020. When I say outdated that is what I am referring to. It is impossible that the NHS could have foresaw such a massive change.

While there is an incentive structure in the NHS between trusts, with better trusts being financially rewarded, this does not translate to boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency.

“Theoretically,” this would lead to better health outcomes. If the public had a degree of choice for their healthcare provider (with a qualifier that these should always be truly affordable) and there was competition between these providers, you would expect prices to be driven down, more efficiency and better outcomes for the general population. As stated before, there should always be a social safety net for those who would be unable to make such a choice.

Would that solve all the problems? Not at all. The only true way out of rapidly ageing first-world countries is likely AI and robotic medicine, something that is being heavily invested in in both China and Japan.

Okay, I can see where you're coming from on this. I used to think some of those things too (when I subscribed to the Economist).

First up, the NHS is a world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed.
https://ceoworld.biz/2021/04/27/reveale ... tems-2021/

Next, you are talking about two separate things: 1) healthcare that is paid for directly by the patient (albeit with a safety net for the poor) and 2) healthcare provided by a collection of competing private healthcare companies. And then you argue that because 2) has some theoretical efficiencies then we should change to a system including 1). But 1) and 2) do not need to go together: a system could include either, neither or both of these features (eg a system could be paid for as the NHS but have GPs choosing the most appropriate private healthcare systems for the patients). So your argument doesn't make the case for 1).

Re your argument for the theoretical advantages of competing private healthcare companies: sure, this is the neoliberal orthodox view, but there are many significant disadvantages:

You'd have a system where there'd be a number of companies, each providing a wide range of health services. As such they'd need to be quite large and so they'd be quite limited in number, so you'd naturally get an oligopoly, dominance by a small number of large entities, which would limit efficiency gains since the situation would be a long way from perfect competition. Most of the 'consumers' of the 'product' are not well informed on the details of medicine, and so would mostly select healthcare based on advertising (that's where they'd actually get a choice and not simply be forced to use the service their employer subscribes them to). Marketing and advertising are not needed by the NHS and so they are an extra inefficiency of the private system. As the entities would be smaller than the NHS, they would be unlikely to have its breadth of expertise. As they are driven by profit they would be uninterested in treating conditions which have high costs. Dividend payments to shareholders do not exist in the NHS model, so are an extra inefficiency of the private system. The primary concern of private companies is profit maximisation not medical excellence: so they would deliver healthcare which meets the minimum they are contracted to deliver, and no more. Also, if the have any access or influence over the decision-making process, they will (for the same reason) seek solutions which maximise profit, rather than the best medical outcomes. If differing levels of medical cover exist in the system, time and effort will be needed to determine which form of care the patient qualifies for - another inefficiency of the system.

These are some of the problems which private companies bring which need to be considered along with efficiency advantages due to competition. However, in the field of healthcare there is the more fundamental issue which may or may not trouble you, depending on your views on equality. My view is that health is something we all have an equal right to, regardless of wealth (or any other factor), and so, unless strict uniformity of product is regulated and maintained, a private system will fall short. And if the private system is allowed to have explicitly different levels of cover (which would presumably be lower for those with the least wealth), then equality of health will be history. That's unacceptable (to me), in a way that it's not in other areas - eg I don't mind if someone has a more expensive car than someone else. That's why I'm more comfortable with a capitalist approach in many (but not all) areas outside of health.

Finally, re your thinking on a lack of incentive for 'boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency'. I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride. (That was even true in the City, which is my background. You choose that line of work at least partly because of the money. But on a day-to-day basis you do good work because of professional pride and team spirit.)

Good post, I agree with a lot of it. Appreciate I haven't answered all your queries but thought I'd clear up what I could.

"world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed."

Never claimed that the change had to be radical. This was my point with my initial post, any discussion of the NHS moving away from a completely free at a point of demand service is a third rail that no one can touch, and is seen as a tell that the individual wants to turn the UK into a pseudo-USA system. Dentistry already isn't free as part of the NHS, but it is heavily subsided to the point where it is affordable to almost everyone if you cannot afford private treatment.

To the best of my ability I have been attempting to describe a Japanese/ South Korean/ Australian style healthcare system. All systems that have a university healthcare safety net but those that can afford it pay health insurance. If those are deemed as being greedy free market healthcare systems that put money before patients then fair enough, my points will fall on deaf ears.

If you think this then perhaps we disagree on the meaning of the word radical.

I took a look at the Australian system (a random pick from your examples). My understanding is that as of 2018 only 45% of medical costs (the % varies by condition) were covered by Medicare (the universal, publicly funded system), due to "standard" costs covered not keeping pace with actual costs charged by providers (which are whatever the provider chooses), and even less for specialist and private hospital fees (where the 45% falls to approx 38% and 34% respectively). Australians are strongly encouraged to take up private medical insurance to make up for this shortfall. This insurance can be purchased in one of 4 tiers (basic, bronze, silver and gold), with each level covering a progressively wider range of conditions.

The Australian system significantly exposes individuals to the costs of their medical care, and allows individuals to purchase better health cover if they are wealthy enough. So much for a universal system, with equal access to health regardless of wealth.

https://en.wikipedia.org/wiki/Health_care_in_Australia
https://www.health.gov.au/sites/default ... heet_1.pdf

I'm interested to know why you're so keen to have such a system replace ours. What advantages do you think this insurance-based approach gives? NB the UK's per capita health spend is lower than Australia's, so it can't be cost.

https://en.wikipedia.org/wiki/List_of_c ... per_capita

I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride.

Paying them well is an incentive. It was much simpler to pay a nurses, consultant's and registrars well when the NHS was a much smaller chunk of GDP, lesser so now with massive GP and hospital bed demand. Then it simply comes down to how you think the money should be raised to make up for this increased demand. Higher taxes? A fair option but comes with it's own issues and would not be a popular policy. Health insurance for people making over X amount? Would be a hugely unpopular policy but would free up money that may otherwise be stored away in savings. Their taxes would also be further helping to subsidise those would couldn't afford it. Of course this is all hypothetical as people would never vote for either.

As long as the government have complete control over NHS funding, then they'll cut every possible pound they can get from nurses and doctors, as wages are the biggest expenditure of healthcare. Whether its conservatives, labour or lib dems, no government is paying the NHS larger salaries out of the goodness of their heart. It's all just a game of incentives to get more people in the workforce. If doctors and nurses leave the NHS because they are feeling underpaid (Which they are in record numbers, a large chunk to australia), there will be no-one to save the patient's life. So yes, inadvertently incentives do save patient's lives. Appreciate that this is a bit of a bait and switch from my previous post where I alluded to more money for more work done but I think you are right, that in itself would not help the general population (But definitely does contribute to greater efficiency in private healthcare in the UK where more surgeries equals more money for the whole theatre team.)

I think you're agreeing with me: medics are already incentivised in the NHS.

I'm not sure what the last bit in brackets means. Do you not know that NHS doctors are paid more if they work more shifts?

TL;DR - Healthcare insurance for those that can afford it benefits the population as it leads to more money in the healthcare system for doctors, nurses and further hospital beds. This however should never be at the expense of unequal health outcomes.

But that's the catch, isn't it? Even in the UK, an individual can jump the queue with cash, which could lead to an earlier, life-saving diagnosis. How much worse would that be in a system where all services are paid for by the individual (albeit with a subsidy)?

I realise this is all a bit of a tangent from what this thread is all about. I dislike the cloak and dagger privatisation, but unless we have frank discussions, as SandyDragon stated, about what may be best for everyone, then the nefariousness will continue. I just think we can consider some of the healthcare tools of the few countries that are more successful than ourselves on almost every measure.

This government will continue in its nefarious ways regardless of any discussions - do you honestly think otherwise?

Sure, we can consider methods used by other countries, but you've yet to make any case to adopt them. I honestly would like to know why you think they may be better. As Cas says, it makes sense* for the Tories to promote this, as they are being paid/funded to do so. But - assuming you're not being paid to say this - why do you?

*That is, a purely mercenary sense, casting aside any consideration of morality and public service.

[padprop]

Okay, I can see where you're coming from on this. I used to think some of those things too (when I subscribed to the Economist).

First up, the NHS is a world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed.

Next, you are talking about two separate things: 1) healthcare that is paid for directly by the patient (albeit with a safety net for the poor) and 2) healthcare provided by a collection of competing private healthcare companies. And then you argue that because 2) has some theoretical efficiencies then we should change to a system including 1). But 1) and 2) do not need to go together: a system could include either, neither or both of these features (eg a system could be paid for as the NHS but have GPs choosing the most appropriate private healthcare systems for the patients). So your argument doesn't make the case for 1).

Re your argument for the theoretical advantages of competing private healthcare companies: sure, this is the neoliberal orthodox view, but there are many significant disadvantages:

You'd have a system where there'd be a number of companies, each providing a wide range of health services. As such they'd need to be quite large and so they'd be quite limited in number, so you'd naturally get an oligopoly, dominance by a small number of large entities, which would limit efficiency gains since the situation would be a long way from perfect competition. Most of the 'consumers' of the 'product' are not well informed on the details of medicine, and so would mostly select healthcare based on advertising (that's where they'd actually get a choice and not simply be forced to use the service their employer subscribes them to). Marketing and advertising are not needed by the NHS and so they are an extra inefficiency of the private system. As the entities would be smaller than the NHS, they would be unlikely to have its breadth of expertise. As they are driven by profit they would be uninterested in treating conditions which have high costs. Dividend payments to shareholders do not exist in the NHS model, so are an extra inefficiency of the private system. The primary concern of private companies is profit maximisation not medical excellence: so they would deliver healthcare which meets the minimum they are contracted to deliver, and no more. Also, if the have any access or influence over the decision-making process, they will (for the same reason) seek solutions which maximise profit, rather than the best medical outcomes. If differing levels of medical cover exist in the system, time and effort will be needed to determine which form of care the patient qualifies for - another inefficiency of the system.

These are some of the problems which private companies bring which need to be considered along with efficiency advantages due to competition. However, in the field of healthcare there is the more fundamental issue which may or may not trouble you, depending on your views on equality. My view is that health is something we all have an equal right to, regardless of wealth (or any other factor), and so, unless strict uniformity of product is regulated and maintained, a private system will fall short. And if the private system is allowed to have explicitly different levels of cover (which would presumably be lower for those with the least wealth), then equality of health will be history. That's unacceptable (to me), in a way that it's not in other areas - eg I don't mind if someone has a more expensive car than someone else. That's why I'm more comfortable with a capitalist approach in many (but not all) areas outside of health.

Finally, re your thinking on a lack of incentive for 'boots on the ground doctors, nurses and surgeons who are rewarded the same regardless of patient satisfaction, health outcomes or treatment efficiency'. I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride. (That was even true in the City, which is my background. You choose that line of work at least partly because of the money. But on a day-to-day basis you do good work because of professional pride and team spirit.)

Good post, I agree with a lot of it. Appreciate I haven't answered all your queries but thought I'd clear up what I could.

"world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed."

Never claimed that the change had to be radical. This was my point with my initial post, any discussion of the NHS moving away from a completely free at a point of demand service is a third rail that no one can touch, and is seen as a tell that the individual wants to turn the UK into a pseudo-USA system. Dentistry already isn't free as part of the NHS, but it is heavily subsided to the point where it is affordable to almost everyone if you cannot afford private treatment.

To the best of my ability I have been attempting to describe a Japanese/ South Korean/ Australian style healthcare system. All systems that have a university healthcare safety net but those that can afford it pay health insurance. If those are deemed as being greedy free market healthcare systems that put money before patients then fair enough, my points will fall on deaf ears.

If you think this then perhaps we disagree on the meaning of the word radical.

I took a look at the Australian system (a random pick from your examples). My understanding is that as of 2018 only 45% of medical costs (the % varies by condition) were covered by Medicare (the universal, publicly funded system), due to "standard" costs covered not keeping pace with actual costs charged by providers (which are whatever the provider chooses), and even less for specialist and private hospital fees (where the 45% falls to approx 38% and 34% respectively). Australians are strongly encouraged to take up private medical insurance to make up for this shortfall. This insurance can be purchased in one of 4 tiers (basic, bronze, silver and gold), with each level covering a progressively wider range of conditions.

The Australian system significantly exposes individuals to the costs of their medical care, and allows individuals to purchase better health cover if they are wealthy enough. So much for a universal system, with equal access to health regardless of wealth.

I'm interested to know why you're so keen to have such a system replace ours. What advantages do you think this insurance-based approach gives? NB the UK's per capita health spend is lower than Australia's, so it can't be cost.

I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride.

Paying them well is an incentive. It was much simpler to pay a nurses, consultant's and registrars well when the NHS was a much smaller chunk of GDP, lesser so now with massive GP and hospital bed demand. Then it simply comes down to how you think the money should be raised to make up for this increased demand. Higher taxes? A fair option but comes with it's own issues and would not be a popular policy. Health insurance for people making over X amount? Would be a hugely unpopular policy but would free up money that may otherwise be stored away in savings. Their taxes would also be further helping to subsidise those would couldn't afford it. Of course this is all hypothetical as people would never vote for either.

As long as the government have complete control over NHS funding, then they'll cut every possible pound they can get from nurses and doctors, as wages are the biggest expenditure of healthcare. Whether its conservatives, labour or lib dems, no government is paying the NHS larger salaries out of the goodness of their heart. It's all just a game of incentives to get more people in the workforce. If doctors and nurses leave the NHS because they are feeling underpaid (Which they are in record numbers, a large chunk to australia), there will be no-one to save the patient's life. So yes, inadvertently incentives do save patient's lives. Appreciate that this is a bit of a bait and switch from my previous post where I alluded to more money for more work done but I think you are right, that in itself would not help the general population (But definitely does contribute to greater efficiency in private healthcare in the UK where more surgeries equals more money for the whole theatre team.)

I think you're agreeing with me: medics are already incentivised in the NHS.

I'm not sure what the last bit in brackets means. Do you not know that NHS doctors are paid more if they work more shifts?

TL;DR - Healthcare insurance for those that can afford it benefits the population as it leads to more money in the healthcare system for doctors, nurses and further hospital beds. This however should never be at the expense of unequal health outcomes.

But that's the catch, isn't it? Even in the UK, an individual can jump the queue with cash, which could lead to an earlier, life-saving diagnosis. How much worse would that be in a system where all services are paid for by the individual (albeit with a subsidy)?

I realise this is all a bit of a tangent from what this thread is all about. I dislike the cloak and dagger privatisation, but unless we have frank discussions, as SandyDragon stated, about what may be best for everyone, then the nefariousness will continue. I just think we can consider some of the healthcare tools of the few countries that are more successful than ourselves on almost every measure.

This government will continue in its nefarious ways regardless of any discussions - do you honestly think otherwise?

Sure, we can consider methods used by other countries, but you've yet to make any case to adopt them. I honestly would like to know why you think they may be better. As Cas says, it makes sense* for the Tories to promote this, as they are being paid/funded to do so. But - assuming you're not being paid to say this - why do you?

*That is, a purely mercenary sense, casting aside any consideration of morality and public service.

I've appreciated the discourse so far but I'll make this my last message as we just seem to have different intuitions surrounding this topic.

The Australian system significantly exposes individuals to the costs of their medical care, and allows individuals to purchase better health cover if they are wealthy enough. So much for a universal system, with equal access to health regardless of wealth.

Yet they have better average health outcomes and healthcare equity than that of the UK as of 2021, with the UK only ranking higher only on access to care, which is to be expected with the structure of the NHS, and one place higher worldwide in care process. Even with healthcare at the point of demand in the UK, this does not equate to true equity. Different hospitals and hospital trusts perform so variably depending on location. Two people may have the same access to GPs and medical hospitals, but if one individual lives in Mid Staffordshire and the other lives in Westminster they are going to get very different medical care. At least with affordable health insurance (That 50% of Australians can afford and is subsided by the government) an individual has an aspect of choice in spite of their location in which they live.

https://www.commonwealthfund.org/public ... ing-poorly

I'm interested to know why you're so keen to have such a system replace ours. What advantages do you think this insurance-based approach gives? NB the UK's per capita health spend is lower than Australia's, so it can't be cost.

Again, it's not a case of being keen or not keen, I very well may be wrong and there people far smarter than me that would argue either side. I'm simply entertaining the thought of a structure that intuitively makes sense to me.

1) As above, patient-based choice in regardless of location.
2) A Rising tide lifts all boats - Cash injection in the healthcare system due to combination of taxation and affordable health insurance for those who can afford. People spending less on healthcare is not the solution if the expectations of that the population expect vs what they actually get are so far apart. Yes, the US healthcare system does not function better as a result of more money being thrown at it, but it is such an anomaly in healthcare and human history that it is foolish to think the UK would become anything akin to this. There are many more comparable examples that I have listed previously.
3) Sustainability - I work in the NHS, I find it difficult to see a future where the system works as effectively as it does now in light of a rapidly aging population, antibiotic resistance and other existential threats. I speak to various members of staff about how much bed pressure and GP appointment pressure has increased in the last 20 years, I honestly do not know what it will be like in 2040. The only solutions I can think of would be technology-based (AI, robotics), a massive increase in percentage of GDP (which would effect other areas such as social care and education) or change in healthcare structure.

I have further reasons but if you vehemently disagree with the first three I doubt they would be convincing.

I'm not sure what the last bit in brackets means. Do you not know that NHS doctors are paid more if they work more shifts?

In private hospitals, theatre staff earn more based on the more operations performed. There are administrative barriers that reduce many surgeons working in the NHS to 1-2 maximum surgeries a day. These are reduced in private surgeries where there are never a lack of hospital porters, surgeons are less likely to be called away due to external factors and pre and post surgery checklists are carried out at a faster rate. Even small factors such as these can result in 4 hip operations a day compared with 2 in an NHS hospital.

This government will continue in its nefarious ways regardless of any discussions - do you honestly think otherwise?

The government will be guided by public opinion, as their goal is to maintain power. This would be true of labour, conservatives or the liberal democrats. When a sample of the UK population was asked individual attitudes toward the NHS and the private sector "43 per cent indicate no general preference for either sector. A further 18 per cent express an active preference for independent sector providers. This is a remarkable result given that ‘social desirability bias’ (the phenomenon of people giving the answer they think they are socially expected to give, rather than disclosing their true views) surely works against these options. Among people born after 1979, only about a third have a general preference for NHS providers."

https://iea.org.uk/wp-content/uploads/2 ... active.pdf

As it socially unacceptable to question the NHS structure in public, the conservatives are aware of a significant amount of the voting pool who are less bullish on the NHS and have likely had perceived negative hospital experiences in the past. It's Brexit 2.0.

If we can actively discuss the NHS in a balanced way in newspapers (Near Impossible), television debates (Unlikely), around the water cooler (Possible) and a consensus is reached in the court of public opinion (One in which I may very well be wrong), then we could see an end to cloak-and-dagger privatisation. At the moment, the conservatives realise that their voting base doesn't mind and it serves their party donors as WhichTyler stated previously.

Happy to discuss this further via inbox if you feel further discourse would be fruitful.

[Son of Mathonwy]

Good post, I agree with a lot of it. Appreciate I haven't answered all your queries but thought I'd clear up what I could.

"world top 10 healthcare system, so it seems strange to want to make our model more like the 30th in the list, the USA. There's certainly no reason to think that radical change is needed."

Never claimed that the change had to be radical. This was my point with my initial post, any discussion of the NHS moving away from a completely free at a point of demand service is a third rail that no one can touch, and is seen as a tell that the individual wants to turn the UK into a pseudo-USA system. Dentistry already isn't free as part of the NHS, but it is heavily subsided to the point where it is affordable to almost everyone if you cannot afford private treatment.

To the best of my ability I have been attempting to describe a Japanese/ South Korean/ Australian style healthcare system. All systems that have a university healthcare safety net but those that can afford it pay health insurance. If those are deemed as being greedy free market healthcare systems that put money before patients then fair enough, my points will fall on deaf ears.

If you think this then perhaps we disagree on the meaning of the word radical.

I took a look at the Australian system (a random pick from your examples). My understanding is that as of 2018 only 45% of medical costs (the % varies by condition) were covered by Medicare (the universal, publicly funded system), due to "standard" costs covered not keeping pace with actual costs charged by providers (which are whatever the provider chooses), and even less for specialist and private hospital fees (where the 45% falls to approx 38% and 34% respectively). Australians are strongly encouraged to take up private medical insurance to make up for this shortfall. This insurance can be purchased in one of 4 tiers (basic, bronze, silver and gold), with each level covering a progressively wider range of conditions.

The Australian system significantly exposes individuals to the costs of their medical care, and allows individuals to purchase better health cover if they are wealthy enough. So much for a universal system, with equal access to health regardless of wealth.

I'm interested to know why you're so keen to have such a system replace ours. What advantages do you think this insurance-based approach gives? NB the UK's per capita health spend is lower than Australia's, so it can't be cost.

I think this is a rather dim view of human nature and very much the economist's theoretical angle on humans as economic units. Do you really think a doctor, nurse or paramedic is going to try harder to save that life because they're thinking of that bonus they'll get? As long as they're paid decently you'll get people of the right calibre entering the profession. Once they're there, I think they do a good job because it's the right thing to do, and professional pride.

Paying them well is an incentive. It was much simpler to pay a nurses, consultant's and registrars well when the NHS was a much smaller chunk of GDP, lesser so now with massive GP and hospital bed demand. Then it simply comes down to how you think the money should be raised to make up for this increased demand. Higher taxes? A fair option but comes with it's own issues and would not be a popular policy. Health insurance for people making over X amount? Would be a hugely unpopular policy but would free up money that may otherwise be stored away in savings. Their taxes would also be further helping to subsidise those would couldn't afford it. Of course this is all hypothetical as people would never vote for either.

As long as the government have complete control over NHS funding, then they'll cut every possible pound they can get from nurses and doctors, as wages are the biggest expenditure of healthcare. Whether its conservatives, labour or lib dems, no government is paying the NHS larger salaries out of the goodness of their heart. It's all just a game of incentives to get more people in the workforce. If doctors and nurses leave the NHS because they are feeling underpaid (Which they are in record numbers, a large chunk to australia), there will be no-one to save the patient's life. So yes, inadvertently incentives do save patient's lives. Appreciate that this is a bit of a bait and switch from my previous post where I alluded to more money for more work done but I think you are right, that in itself would not help the general population (But definitely does contribute to greater efficiency in private healthcare in the UK where more surgeries equals more money for the whole theatre team.)

I think you're agreeing with me: medics are already incentivised in the NHS.

I'm not sure what the last bit in brackets means. Do you not know that NHS doctors are paid more if they work more shifts?

TL;DR - Healthcare insurance for those that can afford it benefits the population as it leads to more money in the healthcare system for doctors, nurses and further hospital beds. This however should never be at the expense of unequal health outcomes.

But that's the catch, isn't it? Even in the UK, an individual can jump the queue with cash, which could lead to an earlier, life-saving diagnosis. How much worse would that be in a system where all services are paid for by the individual (albeit with a subsidy)?

I realise this is all a bit of a tangent from what this thread is all about. I dislike the cloak and dagger privatisation, but unless we have frank discussions, as SandyDragon stated, about what may be best for everyone, then the nefariousness will continue. I just think we can consider some of the healthcare tools of the few countries that are more successful than ourselves on almost every measure.

This government will continue in its nefarious ways regardless of any discussions - do you honestly think otherwise?

Sure, we can consider methods used by other countries, but you've yet to make any case to adopt them. I honestly would like to know why you think they may be better. As Cas says, it makes sense* for the Tories to promote this, as they are being paid/funded to do so. But - assuming you're not being paid to say this - why do you?

*That is, a purely mercenary sense, casting aside any consideration of morality and public service.

I've appreciated the discourse so far but I'll make this my last message as we just seem to have different intuitions surrounding this topic.

The Australian system significantly exposes individuals to the costs of their medical care, and allows individuals to purchase better health cover if they are wealthy enough. So much for a universal system, with equal access to health regardless of wealth.

Yet they have better average health outcomes and healthcare equity than that of the UK as of 2021, with the UK only ranking higher only on access to care, which is to be expected with the structure of the NHS, and one place higher worldwide in care process. Even with healthcare at the point of demand in the UK, this does not equate to true equity. Different hospitals and hospital trusts perform so variably depending on location. Two people may have the same access to GPs and medical hospitals, but if one individual lives in Mid Staffordshire and the other lives in Westminster they are going to get very different medical care. At least with affordable health insurance (That 50% of Australians can afford and is subsided by the government) an individual has an aspect of choice in spite of their location in which they live.

https://www.commonwealthfund.org/public ... ing-poorly

I'm interested to know why you're so keen to have such a system replace ours. What advantages do you think this insurance-based approach gives? NB the UK's per capita health spend is lower than Australia's, so it can't be cost.

Again, it's not a case of being keen or not keen, I very well may be wrong and there people far smarter than me that would argue either side. I'm simply entertaining the thought of a structure that intuitively makes sense to me.

1) As above, patient-based choice in regardless of location.
2) A Rising tide lifts all boats - Cash injection in the healthcare system due to combination of taxation and affordable health insurance for those who can afford. People spending less on healthcare is not the solution if the expectations of that the population expect vs what they actually get are so far apart. Yes, the US healthcare system does not function better as a result of more money being thrown at it, but it is such an anomaly in healthcare and human history that it is foolish to think the UK would become anything akin to this. There are many more comparable examples that I have listed previously.
3) Sustainability - I work in the NHS, I find it difficult to see a future where the system works as effectively as it does now in light of a rapidly aging population, antibiotic resistance and other existential threats. I speak to various members of staff about how much bed pressure and GP appointment pressure has increased in the last 20 years, I honestly do not know what it will be like in 2040. The only solutions I can think of would be technology-based (AI, robotics), a massive increase in percentage of GDP (which would effect other areas such as social care and education) or change in healthcare structure.

I have further reasons but if you vehemently disagree with the first three I doubt they would be convincing.

I'm not sure what the last bit in brackets means. Do you not know that NHS doctors are paid more if they work more shifts?

In private hospitals, theatre staff earn more based on the more operations performed. There are administrative barriers that reduce many surgeons working in the NHS to 1-2 maximum surgeries a day. These are reduced in private surgeries where there are never a lack of hospital porters, surgeons are less likely to be called away due to external factors and pre and post surgery checklists are carried out at a faster rate. Even small factors such as these can result in 4 hip operations a day compared with 2 in an NHS hospital.

This government will continue in its nefarious ways regardless of any discussions - do you honestly think otherwise?

The government will be guided by public opinion, as their goal is to maintain power. This would be true of labour, conservatives or the liberal democrats. When a sample of the UK population was asked individual attitudes toward the NHS and the private sector "43 per cent indicate no general preference for either sector. A further 18 per cent express an active preference for independent sector providers. This is a remarkable result given that ‘social desirability bias’ (the phenomenon of people giving the answer they think they are socially expected to give, rather than disclosing their true views) surely works against these options. Among people born after 1979, only about a third have a general preference for NHS providers."

https://iea.org.uk/wp-content/uploads/2 ... active.pdf

As it socially unacceptable to question the NHS structure in public, the conservatives are aware of a significant amount of the voting pool who are less bullish on the NHS and have likely had perceived negative hospital experiences in the past. It's Brexit 2.0.

If we can actively discuss the NHS in a balanced way in newspapers (Near Impossible), television debates (Unlikely), around the water cooler (Possible) and a consensus is reached in the court of public opinion (One in which I may very well be wrong), then we could see an end to cloak-and-dagger privatisation. At the moment, the conservatives realise that their voting base doesn't mind and it serves their party donors as WhichTyler stated previously.

Happy to discuss this further via inbox if you feel further discourse would be fruitful.

It's been interesting to discuss this, but I won't respond to your points if you don't wish to continue with this publicly.

I will note that the Niemietz publication you reference is a product of the Institute of Economic Affairs, a neoliberal thinktank, funded in an opaque manner but certainly by the tobacco and fossil fuel industries and a prolific climate change denier. That it argues for the replacement of the NHS with a system more suited for the extraction of private profit is hardly a surprise.