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Aneurin Bevan believed that the cost of the NHS would reduce over time as the population got healthier. The current NHS budget is £125Bn/year. Many people thin

by gaius 9y ago

Aneurin Bevan believed that the cost of the NHS would reduce over time as the population got healthier. The current NHS budget is £125Bn/year. Many people think it is underfunded, but noone is willing to name a figure for fully funded. Is it £150Bn, 200, 500? No progress will be made, by either party, until someone stands up and does this.

pbhjpbhj 9y ago
You can't put a figure on it. The system interfaces with every area of life, and with capitalism. Western Capitalism says the amount spent on healthcare should grow until all available money becomes profit for the Capitalists. Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia because it mines the metals that make the earphones used in mp3 players by students training to be teachers, to encourage them to teach more sport to children so that when those children grow up they'll need less heart bypass surgery. Meanwhile the Siberian mine leads to contaminants in the ocean that cause excess cost to all health regimes around the world ... Health encompasses all parts of life, it needs selfless, holistic, planet-wide approach. You could spend £150 Trillion in health and still find more areas of spending to address.
- justinmk 9y ago
  > Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia In other words, central planning doesn't work[1]. NHS was a "special case" that tends towards the general case, as is the tendency of all untouchable mandates. [1] https://en.wikipedia.org/wiki/Economic_calculation_problem https://en.wikipedia.org/wiki/Economic_calculation_problem
  - DanBC 9y ago
    The NHS (in England) hasn't been centrally planned for some time now. That's what CCGs are for. Also, a bunch of stuff (drug and alcohol services, weight loss, smoking cessation, suicide prevention, sexual health, etc etc) isn't even NHS any more, and is part of Public Health which is part of local authorities.
  - pbhjpbhj 9y ago
    I'd go with "you can't centrally plan health within a system of Western Capitalism". Look at the trains in the UK - government was running one major line at a large profit, but they prop up the system as a whole with tax monies, why? It certainly seems like trains (maybe transport) could be centrally planned if you define the limits of the sector carefully.
nugget 9y ago
I don't see how public health can dramatically improve until we start to have radically different conversations about diet across all levels of society. If you follow the money spent in health care it leads directly to obesity and related lifestyle diseases.
- gaius 9y ago
  The NHS spends £11Bn/year on type-2 diabetes, 80% of which according to Diabetes UK is caused by or could be addressed by lifestyle choices. Not just diabetes of course, I don't mean to pick on one subset, I mean the NHS has to spend an awful lot of money on things that really shouldn't be things in the first place. People who really love "our NHS" eat right, exercise, and get enough sleep... The rest are just trying to score cheap political points.
  - nugget 9y ago
    >eat right, exercise, and get enough sleep Of these three, diet has by far the most impact on t2 diabetes. The focus on casual exercise ("10k steps per day") is relatively useless compared to a low-inflammation diet. But there seem to be a lot of perverse incentives and special interests who keep the conversation muddled or focused elsewhere.
    - DanBC 9y ago
      We're not just talking about diabetes though, we're talking about preventable illness, and good exercise does help prevent heart disease and stroke and some other stuff linked to high blood pressure.
  - oligopoly 9y ago
    There's actually quite a few illness that can and often does have origins as 'secondary gain'[0]. It's quite insane that there isn't more done to address root cause. With diabetes-2 I think NHS fails at the point when they don't address people who are at risk. Help people to change their habits by attaching pain and pleasure to their choices and making it personal. This would save NHS lot of money and most importantly help the individual. https://www.goodreads.com/book/show/144873.Healing_Back_Pain[0] https://www.goodreads.com/book/show/144873.Healing_Back_Pain...
jdietrich 9y ago
>The current NHS budget is £125Bn/year. Many people think it is underfunded, but noone is willing to name a figure for fully funded. Is it £150Bn, 200, 500? It's a moving target, because need continues to grow as the population ages. We're in largely uncharted territory, so it's difficult to make long-term cost forecasts. You could always find ways of spending money to improve a healthcare system, so it just doesn't make sense to pick a number ex nihilo. We do have other, better means of determining what a reasonable level of healthcare spending might be on a year-to-year basis. The National Institute for Clinical Excellence have determined a cost-effectiveness threshold of £30,000 per additional Quality-Adjusted Life Year. This threshold is a little bit arbitrary, but it's a reasonable rule-of-thumb as to what treatments provide a net benefit to society. Based on this figure, we can start to calculate a reasonable overall NHS budget from the bottom-up - the NHS needs enough money to provide all the healthcare interventions that NICE has determined to be cost-effective. In addition to cost-effectiveness, we also have benchmarks in terms of quality of care. It might not be clinically significant if someone has to wait three weeks for a GP appointment about their psoriasis or six months for knee surgery, but it matters to the patient. We know that wait times have been going up and patient satisfaction is going down, which is a reasonable indication that the system is underfunded. It wouldn't be reasonable to aim for instant care and 100% patient satisfaction, but we should at the least hope for stability rather than regression. The question of affordability is perfectly fair, but the UK doesn't spend an exceptional amount on healthcare by the standards of equally-developed nations. As a proportion of GDP, our spending is roughly average for OECD nations. In absolute terms, we spend about 25% less per patient than Germany or Ireland. We can clearly afford to spend a fair bit more before we start feeling the pinch. I think that it's perfectly reasonable to spend a few tenths of a percent of our GDP to try and take the pressure off the system and get the quality metrics back to where they were in 2015. If costs start spiralling out of control, then we need to have some difficult conversations about what kind of care we're going to ration, but I think that conversation is premature if we haven't first tried a modest increase in spending.
- makomk 9y ago
  Incidentally, one of the provisions in the ACA over in the US specifically prohibits the use of QALY as a cost-effectiveness threshold. It's just one of many reasons it's so absurd for Americans to point to the NHS as a demonstration of how much more cost-effective healthcare would be if it were nationalised; something like the NHS with its cost-saving measures just wouldn't be politically viable there.

by gaius 9y ago

pbhjpbhj 9y ago

You can't put a figure on it. The system interfaces with every area of life, and with capitalism. Western Capitalism says the amount spent on healthcare should grow until all available money becomes profit for the Capitalists. Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia because it mines the metals that make the earphones used in mp3 players by students training to be teachers, to encourage them to teach more sport to children so that when those children grow up they'll need less heart bypass surgery. Meanwhile the Siberian mine leads to contaminants in the ocean that cause excess cost to all health regimes around the world ... Health encompasses all parts of life, it needs selfless, holistic, planet-wide approach. You could spend £150 Trillion in health and still find more areas of spending to address.

justinmk 9y ago
> Meanwhile there's always some new area of life that impacts health - spend on sport, then on encouraging sport by paying for teachers, then on improving colleges where the teachers train, ... before you know it the NHS is funding a deep mine in Siberia In other words, central planning doesn't work[1]. NHS was a "special case" that tends towards the general case, as is the tendency of all untouchable mandates. [1] https://en.wikipedia.org/wiki/Economic_calculation_problem https://en.wikipedia.org/wiki/Economic_calculation_problem
- DanBC 9y ago
  The NHS (in England) hasn't been centrally planned for some time now. That's what CCGs are for. Also, a bunch of stuff (drug and alcohol services, weight loss, smoking cessation, suicide prevention, sexual health, etc etc) isn't even NHS any more, and is part of Public Health which is part of local authorities.
- pbhjpbhj 9y ago
  I'd go with "you can't centrally plan health within a system of Western Capitalism". Look at the trains in the UK - government was running one major line at a large profit, but they prop up the system as a whole with tax monies, why? It certainly seems like trains (maybe transport) could be centrally planned if you define the limits of the sector carefully.

nugget 9y ago

I don't see how public health can dramatically improve until we start to have radically different conversations about diet across all levels of society. If you follow the money spent in health care it leads directly to obesity and related lifestyle diseases.

gaius 9y ago
The NHS spends £11Bn/year on type-2 diabetes, 80% of which according to Diabetes UK is caused by or could be addressed by lifestyle choices. Not just diabetes of course, I don't mean to pick on one subset, I mean the NHS has to spend an awful lot of money on things that really shouldn't be things in the first place. People who really love "our NHS" eat right, exercise, and get enough sleep... The rest are just trying to score cheap political points.
- nugget 9y ago
  >eat right, exercise, and get enough sleep Of these three, diet has by far the most impact on t2 diabetes. The focus on casual exercise ("10k steps per day") is relatively useless compared to a low-inflammation diet. But there seem to be a lot of perverse incentives and special interests who keep the conversation muddled or focused elsewhere.
  - DanBC 9y ago
    We're not just talking about diabetes though, we're talking about preventable illness, and good exercise does help prevent heart disease and stroke and some other stuff linked to high blood pressure.
- oligopoly 9y ago
  There's actually quite a few illness that can and often does have origins as 'secondary gain'[0]. It's quite insane that there isn't more done to address root cause. With diabetes-2 I think NHS fails at the point when they don't address people who are at risk. Help people to change their habits by attaching pain and pleasure to their choices and making it personal. This would save NHS lot of money and most importantly help the individual. https://www.goodreads.com/book/show/144873.Healing_Back_Pain[0] https://www.goodreads.com/book/show/144873.Healing_Back_Pain...

jdietrich 9y ago

>The current NHS budget is £125Bn/year. Many people think it is underfunded, but noone is willing to name a figure for fully funded. Is it £150Bn, 200, 500? It's a moving target, because need continues to grow as the population ages. We're in largely uncharted territory, so it's difficult to make long-term cost forecasts. You could always find ways of spending money to improve a healthcare system, so it just doesn't make sense to pick a number ex nihilo. We do have other, better means of determining what a reasonable level of healthcare spending might be on a year-to-year basis. The National Institute for Clinical Excellence have determined a cost-effectiveness threshold of £30,000 per additional Quality-Adjusted Life Year. This threshold is a little bit arbitrary, but it's a reasonable rule-of-thumb as to what treatments provide a net benefit to society. Based on this figure, we can start to calculate a reasonable overall NHS budget from the bottom-up - the NHS needs enough money to provide all the healthcare interventions that NICE has determined to be cost-effective. In addition to cost-effectiveness, we also have benchmarks in terms of quality of care. It might not be clinically significant if someone has to wait three weeks for a GP appointment about their psoriasis or six months for knee surgery, but it matters to the patient. We know that wait times have been going up and patient satisfaction is going down, which is a reasonable indication that the system is underfunded. It wouldn't be reasonable to aim for instant care and 100% patient satisfaction, but we should at the least hope for stability rather than regression. The question of affordability is perfectly fair, but the UK doesn't spend an exceptional amount on healthcare by the standards of equally-developed nations. As a proportion of GDP, our spending is roughly average for OECD nations. In absolute terms, we spend about 25% less per patient than Germany or Ireland. We can clearly afford to spend a fair bit more before we start feeling the pinch. I think that it's perfectly reasonable to spend a few tenths of a percent of our GDP to try and take the pressure off the system and get the quality metrics back to where they were in 2015. If costs start spiralling out of control, then we need to have some difficult conversations about what kind of care we're going to ration, but I think that conversation is premature if we haven't first tried a modest increase in spending.

makomk 9y ago
Incidentally, one of the provisions in the ACA over in the US specifically prohibits the use of QALY as a cost-effectiveness threshold. It's just one of many reasons it's so absurd for Americans to point to the NHS as a demonstration of how much more cost-effective healthcare would be if it were nationalised; something like the NHS with its cost-saving measures just wouldn't be politically viable there.