4 ms·

>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

by 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
      >> The govt has rules for borrowing from the capital market Yeah it does. The UK govt has had 6 different sets of rules in only the past 10 years. The current rules followed by Rishi Sunak are actively opposed to what you say - he’s been celebrating beating borrowing forecasts of the OBR by £26bn, and he makes a big song and dance any time he can stating excessive public borrowing is immoral. He found the magic money tree instead… The scope of quantitative easing has increased massively since it was introduced. On top of this, the bank of england does not publish a report on which govt bonds have matured - but we know some have already without having been sold. So, the govt borrowed from the govt (bank of england bought out uk govt bonds held by non govt entities) then held them to maturity (so the govt paid the govt back), while remitting the coupon payments back to the govt. All while we can’t see inside the machine - none of this is available via public reporting. It’s not quite “printing money” but it definitely qualifies as a magic money tree. It’s how govt’s corona responses are paid for today and it’s the reason NHS funding is constrained not by tax receipts but by policy, political decision.

by pydry 5y ago

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
    >> The govt has rules for borrowing from the capital market Yeah it does. The UK govt has had 6 different sets of rules in only the past 10 years. The current rules followed by Rishi Sunak are actively opposed to what you say - he’s been celebrating beating borrowing forecasts of the OBR by £26bn, and he makes a big song and dance any time he can stating excessive public borrowing is immoral. He found the magic money tree instead… The scope of quantitative easing has increased massively since it was introduced. On top of this, the bank of england does not publish a report on which govt bonds have matured - but we know some have already without having been sold. So, the govt borrowed from the govt (bank of england bought out uk govt bonds held by non govt entities) then held them to maturity (so the govt paid the govt back), while remitting the coupon payments back to the govt. All while we can’t see inside the machine - none of this is available via public reporting. It’s not quite “printing money” but it definitely qualifies as a magic money tree. It’s how govt’s corona responses are paid for today and it’s the reason NHS funding is constrained not by tax receipts but by policy, political decision.