3 ms·

> The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. It really isn't underfunded. It's grossly inefficient

> The NHS (despite fairly extreme under-funding) has better health outcomes for patients than in the US. It really isn't underfunded. It's grossly inefficient, which is what happens to most if not all publicly funded bodies. It is actually ok to criticise the NHS organization. They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. They (currently?) refused to recycle crutches, plastic casts and so on. They'll use their own (hospital pharmacy) drugs if you get admitted, and then discharge you with them, even if you have your own dosette box and refuse to take theirs back. My father was discharged with something in the region of £3-5000 pounds of drugs that we threw away on several occasions. As a percentage of GDP, it's roughly the same as most other western countries. Of most interest though is figure 3 in [2] - 80% of UK (NHS) funding came from public money, i.e. tax, and 20% from private money (e.g. insurance). For the US, it's 50% public money (tax), and 50% private money. I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. And compound interest (increase the NHS by 10% per annum!!) means we'd spend all our GDP on the NHS at some point rather quickly. [1] https://www.statista.com/statistics/317708/healthcare-expenditure-as-a-share-of-gdp-in-the-united-kingdom/ https://www.statista.com/statistics/317708/healthcare-expend... [2] https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthcaresystem/articles/howdoesukhealthcarespendingcomparewithothercountries/2019-08-29 https://www.ons.gov.uk/peoplepopulationandcommunity/healthan...

pydry 5y ago
>They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power). Pretty much any trade deal negotiations with the US involve the UK being asked to dial down NHS buying power on behalf of pharmas by making hospitals responsible for purchasing. >As a percentage of GDP, it's roughly the same as most other western countries. 50% of the US - not because the UK is especially efficient but because the US healthcare is essentially legalized extortion. >I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises. It's very very popular. In no small part because we can see how much of a racket the US is. The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years. Part of this has been done by handing over chunks of the NHS to be run privately and incompetently by friends and donors of the party. The problems caused by this backdoor privatization will later be "fixed" with privatization. Whatever the problem, privatization will forever be the answer. The tories argued for an American style healthcare system in 1948 and while they give tacit acknowledgement of the popularity of the NHS their views havent changed (Christopher Chope is a good bellwether of their more unsightly "hidden" views), they still want a US style system.
- DrBazza 5y ago
  > You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power). In principle, you're correct. In practice the fact that they're the only buyer, means in many cases that they pay at whatever a drugs company sells at since there's no "but company X is only paying Y, why are you charging us Z" as a comparison, particularly in the case of non-generics. > The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises. And that was exactly my point. The UK public might "adore" the NHS, but they have a pretty poor understanding of how it is funded. If the government kept funding the NHS by an extra X percent every year, we run out of public funds. > The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years. The ruling party, being the Tories, that have been "in charge" of the NHS for the majority of its 70 or so years? And who on earth would buy a loss making healthcare system that's funded to the tune of a billion or so a week? Apple?
  - CraigJPerry 5y ago
    >> If the government kept funding the NHS by an extra X percent every year, we run out of public funds Lets say the uk gov allocated 10x to the nhs in the next budget - to be clear, this would put just nhs spending at more than total govt income for the year. If this were a company we’re talking about, they’d be insolvent. But we’re talking about a govt with a sovereign currency. So what would happen in this scenario? It doesn’t go bankrupt… How is money created? What is fractional reserve lending? How is money destroyed? Can a country issue a fiat currency without an associated public debt? Or to put that last bit another way - could you settle your tax bill in GBP if there was £0 public debt?
    - DrBazza 5y ago
      The govt has rules for borrowing from the capital market, and that's (mostly?) for national infrastructure projects. It will never (hopefully) borrow from the capital markets to fund the NHS, and then continually pay it off. That leaves tax or private money to fund the NHS, and we can't tax people much more. So in your comment "how is the money created?" Answer, tax, and there's a maximum limit to how much we can fund the NHS.
CraigJPerry 5y ago
>> It's grossly inefficient I think it’s more nuanced than that. There’s inefficiencies for sure but we need perspective to assess them against. E.g. A triple heart bypass, the most common major heart surgery in the world, costs: Approx 110k USD in the US system Approx 50k EUR (56k USD) in Germany And just under 9k GBP (12k USD) in the UK >> I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money Can you clarify what you mean by “come up with” in the context of the GBP which is a fiat currency?
TMWNN 5y ago
>I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. Relevant: Private Eye on "24 Hours to Save the NHS": (<https://twitter.com/KulganofCrydee/status/833654730849136641 https://twitter.com/KulganofCrydee/status/833654730849136641>)

pydry 5y ago

>They're a monopsony, so actually get absolutely gouged by the pharmaceutical companies. You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power). Pretty much any trade deal negotiations with the US involve the UK being asked to dial down NHS buying power on behalf of pharmas by making hospitals responsible for purchasing. >As a percentage of GDP, it's roughly the same as most other western countries. 50% of the US - not because the UK is especially efficient but because the US healthcare is essentially legalized extortion. >I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises. It's very very popular. In no small part because we can see how much of a racket the US is. The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years. Part of this has been done by handing over chunks of the NHS to be run privately and incompetently by friends and donors of the party. The problems caused by this backdoor privatization will later be "fixed" with privatization. Whatever the problem, privatization will forever be the answer. The tories argued for an American style healthcare system in 1948 and while they give tacit acknowledgement of the popularity of the NHS their views havent changed (Christopher Chope is a good bellwether of their more unsightly "hidden" views), they still want a US style system.

DrBazza 5y ago
> You've got that exactly back to front. NHS's immense buying power lets them negotiate lower prices for drugs, exactly as medicare used to (before pharma lobbying stripped them of that power). In principle, you're correct. In practice the fact that they're the only buyer, means in many cases that they pay at whatever a drugs company sells at since there's no "but company X is only paying Y, why are you charging us Z" as a comparison, particularly in the case of non-generics. > The UK public adores the NHS and is one of the few things polls say that people would be happy to fund with tax raises. And that was exactly my point. The UK public might "adore" the NHS, but they have a pretty poor understanding of how it is funded. If the government kept funding the NHS by an extra X percent every year, we run out of public funds. > The ruling party does not like it, however, which is why it has been slowly degrading service over time as preparation for full privatization in 10-15 years. The ruling party, being the Tories, that have been "in charge" of the NHS for the majority of its 70 or so years? And who on earth would buy a loss making healthcare system that's funded to the tune of a billion or so a week? Apple?
- CraigJPerry 5y ago
  >> If the government kept funding the NHS by an extra X percent every year, we run out of public funds Lets say the uk gov allocated 10x to the nhs in the next budget - to be clear, this would put just nhs spending at more than total govt income for the year. If this were a company we’re talking about, they’d be insolvent. But we’re talking about a govt with a sovereign currency. So what would happen in this scenario? It doesn’t go bankrupt… How is money created? What is fractional reserve lending? How is money destroyed? Can a country issue a fiat currency without an associated public debt? Or to put that last bit another way - could you settle your tax bill in GBP if there was £0 public debt?
  - DrBazza 5y ago
    The govt has rules for borrowing from the capital market, and that's (mostly?) for national infrastructure projects. It will never (hopefully) borrow from the capital markets to fund the NHS, and then continually pay it off. That leaves tax or private money to fund the NHS, and we can't tax people much more. So in your comment "how is the money created?" Answer, tax, and there's a maximum limit to how much we can fund the NHS.

CraigJPerry 5y ago

>> It's grossly inefficient I think it’s more nuanced than that. There’s inefficiencies for sure but we need perspective to assess them against. E.g. A triple heart bypass, the most common major heart surgery in the world, costs: Approx 110k USD in the US system Approx 50k EUR (56k USD) in Germany And just under 9k GBP (12k USD) in the UK >> I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money Can you clarify what you mean by “come up with” in the context of the GBP which is a fiat currency?

TMWNN 5y ago

>I'm not sure how much more money the UK general public really thinks the UK government can come up with to keep giving the NHS "more!" money. There's a limit to how much people can be taxed. Relevant: Private Eye on "24 Hours to Save the NHS": (<https://twitter.com/KulganofCrydee/status/833654730849136641 https://twitter.com/KulganofCrydee/status/833654730849136641>)