4 ms·

We are never going to get a serious debate around reforming the NHS until people move on from only comparing the UK to the US. There are many other systems that

by scrlk 4y ago

We are never going to get a serious debate around reforming the NHS until people move on from only comparing the UK to the US. There are many other systems that work - people only need to look across to Europe.

kergonath 4y ago
> people only need to look across to Europe That would be politically risky these days… The UK needs to come back to Earth before this happens.
- heurisko 4y ago
  It's the EU that arguably needs to come back to earth, by returning to a trading bloc, rather than a halfway house pan-european state. The shared monetary system with no shared fiscal policy will come apart one day, as it nearly did with the Greek sovereign debt crisis.
  - kergonath 4y ago
    > It's the EU that arguably needs to come back to earth, by returning to a trading bloc, rather than a halfway house pan-european state. This old chestnut. Go read the Rome treaty or the Schuman declaration. The “it’s only economic” is a lie you’ve been sold by your own governments. The aim has always been political Union, from the beginning. Besides, the EU being “a trading bloc” would not solve any of the issues facing the British government, which mostly result from the government having mutually exclusive demands and being unwilling to keep its word and following the agreements it signed. Including on imports and exports, which is the essence of a trading bloc and would not be improved one bit of the EU were only one of those.
    - okeuro49 4y ago
      > This old chestnut. Go read the Rome treaty or the Schuman declaration. The “it’s only economic” is a lie you’ve been sold by your own governments. The aim has always been political Union, from the beginning. That's not true. The Schuman declaration refers to the European Coal and Steel Community, which was about making war between countries materially impossible ie. through economic, not political, integration. It doesn't refer to stopping war by creating a common European Parliament with the idea that French and Germans should be subsumed into a European citzenry, with freedom of movement. Similarly, the Rome treaty established the European Economic Community. The idea of European citzenship being only established with Maastricht as late as 1992. The history of the European Union has been that of economic integration, with political union coming afterwards. There are many who would have preferred it not come afterwards. To characterise the project soley in terms of those who wanted a pan-European political project is misleading. Political union has not really worked. The European Parliament is a weak institution, and the sovereign debt crisis showed how unpleasant the democratic deficit is, in this case for everyday Greek citizens, as the European Commission forced through austerity measures, triggering a humanitarian crisis. > Including on imports and exports, which is the essence of a trading bloc and would not be improved one bit of the EU were only one of those. The red line for the UK government is freedom of movement. If the EU remained someething akin to ASEAN, ie. prior to Maastricht, the UK would rejoin, and everyone would enjoy sensible trading amongst similarly economically developed countries again. The EU's dream of German and Greek citizens voting together as "EU citizens" in powerful European Parliament on fiscal issues such as a shared pension age and sharing taxes, will never happen, so we have to wait until that folly is over and peoples using the Euro will continue to find out that they have ceded their democracies to undemocratic institutions.
      - kergonath 4y ago
        > The Schuman declaration refers to the European Coal and Steel Community, which was about making war between countries materially impossible ie. through economic, not political, integration. Right, I’ll quote it here for you: “The contribution which an organized and living Europe can bring to civilization is indispensable to the maintenance of peaceful relations. In taking upon herself for more than 20 years the role of champion of a united Europe, France has always had as her essential aim the service of peace. A united Europe was not achieved and we had war. Europe will not be made all at once, or according to a single plan. It will be built through concrete achievements which first create a de facto solidarity. The coming together of the nations of Europe requires the elimination of the age-old opposition of France and Germany. Any action taken must in the first place concern these two countries. With this aim in view, the French Government proposes that action be taken immediately on one limited but decisive point.” The CECA was from the begining the first step towards “a United Europe”, however close that unification might be. They just realised that they needed gradual steps. You can disagree with the steps, their size, and their frequency, but the end goal was explicit from the beginning. > The red line for the UK government is freedom of movement. And the common agriculture policy. And the fisheries policy. And the customs union. And the human rights. And Ireland. The British government had a lot of incompatible red lines from the beginning. This was obvious to anyone who has been paying attention. > If the EU remained someething akin to ASEAN, ie. prior to Maastricht, the UK would rejoin, and everyone would enjoy sensible trading amongst similarly economically developed countries again. That was a position (participation in the EEA but not the EU) the UK did not want to take. Besides, it was not even realistic in the first time. We are not in the 1980s anymore and Europe has changed quite a bit since then. > The EU's dream of German and Greek citizens voting together as "EU citizens" in powerful European Parliament on fiscal issues such as a shared pension age and sharing taxes That is not going to happen, at least in the foreseeable future, for several reasons. The first one being that the member states consider that their national sovereignty and they are the one pulling strings in the council. The Parliament cannot do that on its own, it’s just a convenient straw man. > will never happen, so we have to wait until that folly is over and peoples using the Euro will continue to find out that they have ceded their democracies to undemocratic institutions. More undemocratic than the Parliament in Westminster? You must be joking. And how accountable is the Bank of England? But yeah, rule Britannia. Also, you forget that the British government pushed all the way along this drift towards a more neo-liberal, insulated from the whims of its populations, Europe.
- Fiahil 4y ago
  We (France) like to compare our sécurité sociale to the NHS, but only to remember that ours is not so bad after all. It’s never been the subject of serious debates, and the USA even less (rightfully).
dominotw 4y ago
> people only need to look across to Europe. No they shouldn't be looking europe. Modern healthcare is subsidization of chronically obese people by healthy working class. UK is the most obese country in western europe. Their situation is different cannot be solved by copying ideas from other healthy countries in europe.
Mordisquitos 4y ago
In fact, I would argue that for all its possible faults (which all systems have) the fundamental problem with the NHS is not in how it is structured or in its processes. Rather, it boils down to funding. Nothing else. Just that. The one feature that the NHS has proven time and time again is that it is one of the most cost-efficient healthcare systems in the World, and given that it is working suboptimally that is a clear sign that the NHS needs a significantly greater (and stable and dependable in the long-term) financial investment. Once that is sorted, all other further changes and optimisations that may be needed can be worked on. But debating how the NHS needs to be reformed today is arguing on the helm of the Titanic on how to improve its unsinkability while it sails merrily towards an iceberg.
- origin_path 4y ago
  NHS funding increases constantly over time, often by massive amounts. The NHS is currently not merely suboptimal. You could have argued that before Team Expert came along in 2020 but not now. It's totally collapsed. There are now people routinely dying whilst waiting to be seen in A&E let alone the massive backlog for cancer. By any metric the NHS in 2022 has completely ceased to function properly. There seem to be a lot of British people in denial of this fact. The NHS is dead. The only reason it still exists at all is because it isn't a company so the usual safety systems like bankruptcy can't force a reset. Note that other countries which spend comparable amounts don't have this problem. I'm lucky enough to have left the UK a long time ago and lines in a party of Europe where the healthcare system is easy more privatised and less controlled by the government. Things here are normal, good even and I can get seen by a gp or specialist more or less immediately.
  - Mordisquitos 4y ago
    Still, merely "more vs. less" privatisation is not the determinant factor. Case in point, I currently live in Spain where universal healthcare is fully public as is the NHS(*), and over time decentralised and became fully devolved to each of the 17 autonomous communities (almost federal states in all but technicalities). In general, from a user's perspective, Spanish healthcare tends to work better than the NHS in many regards, albeit with less flexibility at the GP level and more of a hassle when moving between regions. Anecdotally, from the experience of Spanish friends having lived in countries with a more or less public-private model (Belgium, Germany, Ireland) have expressed that the systems there are generally worse, and miss the Spanish healthcare system. However, different regional governmens have made a greater or lesser move towards covert privatisation via externalisation, and while the two that have done it the most (Catalonia and Madrid) are generally the worst performers, there is little correlation otherwise. The Basque Country, Navarre, Asturias and Aragon are all top performers, yet the first two have privatised significantly while the latter two have kept the system more fully public. On the other hand, Andalusia with very little privatisation is together with Madrid and Catalonia as one of the worse. And yet, when compared by investment, the pattern becomes much more clear. Madrid, Catalonia and Andalusia have some of the lowest healthcare investment per capita. The Basque Country, Navarre, Asturias are some of the greatest investers—Aragon not so much, but still on the top end of the scale. (*) As a digression, due to historical differences in how each system evolved, they are not quite the same. Spanish healthcare evolved from Social Security, and thus used to require being either employed, officially on unemployment, or being a dependant of someone in either circumstance (now it's more lenient). Also, all doctors involved are state employees. The NHS on the other hand evolved as a right of all legal residents of the UK, and GPs surgeries are almost always private businesses that are adscribed to the NHS.

by scrlk 4y ago

kergonath 4y ago

> people only need to look across to Europe That would be politically risky these days… The UK needs to come back to Earth before this happens.

heurisko 4y ago
It's the EU that arguably needs to come back to earth, by returning to a trading bloc, rather than a halfway house pan-european state. The shared monetary system with no shared fiscal policy will come apart one day, as it nearly did with the Greek sovereign debt crisis.
- kergonath 4y ago
  > It's the EU that arguably needs to come back to earth, by returning to a trading bloc, rather than a halfway house pan-european state. This old chestnut. Go read the Rome treaty or the Schuman declaration. The “it’s only economic” is a lie you’ve been sold by your own governments. The aim has always been political Union, from the beginning. Besides, the EU being “a trading bloc” would not solve any of the issues facing the British government, which mostly result from the government having mutually exclusive demands and being unwilling to keep its word and following the agreements it signed. Including on imports and exports, which is the essence of a trading bloc and would not be improved one bit of the EU were only one of those.
  - okeuro49 4y ago
    > This old chestnut. Go read the Rome treaty or the Schuman declaration. The “it’s only economic” is a lie you’ve been sold by your own governments. The aim has always been political Union, from the beginning. That's not true. The Schuman declaration refers to the European Coal and Steel Community, which was about making war between countries materially impossible ie. through economic, not political, integration. It doesn't refer to stopping war by creating a common European Parliament with the idea that French and Germans should be subsumed into a European citzenry, with freedom of movement. Similarly, the Rome treaty established the European Economic Community. The idea of European citzenship being only established with Maastricht as late as 1992. The history of the European Union has been that of economic integration, with political union coming afterwards. There are many who would have preferred it not come afterwards. To characterise the project soley in terms of those who wanted a pan-European political project is misleading. Political union has not really worked. The European Parliament is a weak institution, and the sovereign debt crisis showed how unpleasant the democratic deficit is, in this case for everyday Greek citizens, as the European Commission forced through austerity measures, triggering a humanitarian crisis. > Including on imports and exports, which is the essence of a trading bloc and would not be improved one bit of the EU were only one of those. The red line for the UK government is freedom of movement. If the EU remained someething akin to ASEAN, ie. prior to Maastricht, the UK would rejoin, and everyone would enjoy sensible trading amongst similarly economically developed countries again. The EU's dream of German and Greek citizens voting together as "EU citizens" in powerful European Parliament on fiscal issues such as a shared pension age and sharing taxes, will never happen, so we have to wait until that folly is over and peoples using the Euro will continue to find out that they have ceded their democracies to undemocratic institutions.
    - kergonath 4y ago
      > The Schuman declaration refers to the European Coal and Steel Community, which was about making war between countries materially impossible ie. through economic, not political, integration. Right, I’ll quote it here for you: “The contribution which an organized and living Europe can bring to civilization is indispensable to the maintenance of peaceful relations. In taking upon herself for more than 20 years the role of champion of a united Europe, France has always had as her essential aim the service of peace. A united Europe was not achieved and we had war. Europe will not be made all at once, or according to a single plan. It will be built through concrete achievements which first create a de facto solidarity. The coming together of the nations of Europe requires the elimination of the age-old opposition of France and Germany. Any action taken must in the first place concern these two countries. With this aim in view, the French Government proposes that action be taken immediately on one limited but decisive point.” The CECA was from the begining the first step towards “a United Europe”, however close that unification might be. They just realised that they needed gradual steps. You can disagree with the steps, their size, and their frequency, but the end goal was explicit from the beginning. > The red line for the UK government is freedom of movement. And the common agriculture policy. And the fisheries policy. And the customs union. And the human rights. And Ireland. The British government had a lot of incompatible red lines from the beginning. This was obvious to anyone who has been paying attention. > If the EU remained someething akin to ASEAN, ie. prior to Maastricht, the UK would rejoin, and everyone would enjoy sensible trading amongst similarly economically developed countries again. That was a position (participation in the EEA but not the EU) the UK did not want to take. Besides, it was not even realistic in the first time. We are not in the 1980s anymore and Europe has changed quite a bit since then. > The EU's dream of German and Greek citizens voting together as "EU citizens" in powerful European Parliament on fiscal issues such as a shared pension age and sharing taxes That is not going to happen, at least in the foreseeable future, for several reasons. The first one being that the member states consider that their national sovereignty and they are the one pulling strings in the council. The Parliament cannot do that on its own, it’s just a convenient straw man. > will never happen, so we have to wait until that folly is over and peoples using the Euro will continue to find out that they have ceded their democracies to undemocratic institutions. More undemocratic than the Parliament in Westminster? You must be joking. And how accountable is the Bank of England? But yeah, rule Britannia. Also, you forget that the British government pushed all the way along this drift towards a more neo-liberal, insulated from the whims of its populations, Europe.
Fiahil 4y ago
We (France) like to compare our sécurité sociale to the NHS, but only to remember that ours is not so bad after all. It’s never been the subject of serious debates, and the USA even less (rightfully).

dominotw 4y ago

> people only need to look across to Europe. No they shouldn't be looking europe. Modern healthcare is subsidization of chronically obese people by healthy working class. UK is the most obese country in western europe. Their situation is different cannot be solved by copying ideas from other healthy countries in europe.

Mordisquitos 4y ago

In fact, I would argue that for all its possible faults (which all systems have) the fundamental problem with the NHS is not in how it is structured or in its processes. Rather, it boils down to funding. Nothing else. Just that. The one feature that the NHS has proven time and time again is that it is one of the most cost-efficient healthcare systems in the World, and given that it is working suboptimally that is a clear sign that the NHS needs a significantly greater (and stable and dependable in the long-term) financial investment. Once that is sorted, all other further changes and optimisations that may be needed can be worked on. But debating how the NHS needs to be reformed today is arguing on the helm of the Titanic on how to improve its unsinkability while it sails merrily towards an iceberg.

origin_path 4y ago
NHS funding increases constantly over time, often by massive amounts. The NHS is currently not merely suboptimal. You could have argued that before Team Expert came along in 2020 but not now. It's totally collapsed. There are now people routinely dying whilst waiting to be seen in A&E let alone the massive backlog for cancer. By any metric the NHS in 2022 has completely ceased to function properly. There seem to be a lot of British people in denial of this fact. The NHS is dead. The only reason it still exists at all is because it isn't a company so the usual safety systems like bankruptcy can't force a reset. Note that other countries which spend comparable amounts don't have this problem. I'm lucky enough to have left the UK a long time ago and lines in a party of Europe where the healthcare system is easy more privatised and less controlled by the government. Things here are normal, good even and I can get seen by a gp or specialist more or less immediately.
- Mordisquitos 4y ago
  Still, merely "more vs. less" privatisation is not the determinant factor. Case in point, I currently live in Spain where universal healthcare is fully public as is the NHS(*), and over time decentralised and became fully devolved to each of the 17 autonomous communities (almost federal states in all but technicalities). In general, from a user's perspective, Spanish healthcare tends to work better than the NHS in many regards, albeit with less flexibility at the GP level and more of a hassle when moving between regions. Anecdotally, from the experience of Spanish friends having lived in countries with a more or less public-private model (Belgium, Germany, Ireland) have expressed that the systems there are generally worse, and miss the Spanish healthcare system. However, different regional governmens have made a greater or lesser move towards covert privatisation via externalisation, and while the two that have done it the most (Catalonia and Madrid) are generally the worst performers, there is little correlation otherwise. The Basque Country, Navarre, Asturias and Aragon are all top performers, yet the first two have privatised significantly while the latter two have kept the system more fully public. On the other hand, Andalusia with very little privatisation is together with Madrid and Catalonia as one of the worse. And yet, when compared by investment, the pattern becomes much more clear. Madrid, Catalonia and Andalusia have some of the lowest healthcare investment per capita. The Basque Country, Navarre, Asturias are some of the greatest investers—Aragon not so much, but still on the top end of the scale. (*) As a digression, due to historical differences in how each system evolved, they are not quite the same. Spanish healthcare evolved from Social Security, and thus used to require being either employed, officially on unemployment, or being a dependant of someone in either circumstance (now it's more lenient). Also, all doctors involved are state employees. The NHS on the other hand evolved as a right of all legal residents of the UK, and GPs surgeries are almost always private businesses that are adscribed to the NHS.