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Why should it be an option? Because we live in a free country, and should be free to spend our money as we see fit. Even if others don't agree with it. Why s

by rleigh 4y ago

Why should it be an option? Because we live in a free country, and should be free to spend our money as we see fit. Even if others don't agree with it. Why should we all be compelled by the force of law to divert a huge fraction of our income to an organisation which is so ineffective and inaccessible? We are forced to spend a significant fraction of our salaries on the NHS whether or not we want to. If we feel that this is not good value for money, or of poor quality, we don't have any real option of choosing to pay an alternative provider. Like all nationalised industries, it's inefficiently run because top-down administration of huge organisations blunts initiative and freedom of action. It's run by Whitehall and politicians, with little input from those actually doing the real work. And the result is that it's in perpetual crisis, with COVID having pushed it right over the edge. Is it really fit for purpose? I don't personally think so, and haven't for many years. Competition is good for many reasons. It improves the quality and value of goods and services. The NHS has no real competition. There's no direct cost of failure, no direct cost to poor purchasing decisions, no direct cost for poor quality of service, and no real driving reason for improvement in the quality and efficiency of its services. They get the money anyway. Other healthcare systems in Europe have fully private provision--you have the choice of where to take your money, even if you paid into a public system. If a particular hospital or clinic is providing poor or expensive service, you can take your money elsewhere which is better quality and better value for money. That's a very real incentive to drive improvement and efficiency. That is not the case for the NHS system. There is no choice, and the incentives to improve are minimal. If there is to ever be any improvement in the NHS, there needs to be competition. The NHS should be somewhere you choose to have treatment because it's the best option, not because it's the only option.

gautamcgoel 4y ago
Isn't your argument really an argument against paying taxes in general?
- rleigh 4y ago
  It wasn't intended to be so, but overall I do think that taxes could be reduced significantly. I do think that taxes are used inefficiently and that individuals are better at making decisions in their own and local interests in place of poorly-accountable bureaucracies. But I certainly am not advocating for not paying taxes at all!
ricardobayes 4y ago
Even though I agree with your comment, I don't know of any European countries where you could opt-out from paying social security. Even if some small eastern european country has this option, it is probably unsustainable for a larger country (or one with more healthcare spending).
- rleigh 4y ago
  It could be done multiple ways. You could pay into a government insurance scheme or you could pay into a private one. The main point is that the payment of the insurance premiums is decoupled from the service provision. Right now the two are tightly-coupled and you can't realistically choose either of them. Look at the French model as an example. On a small scale, there is some degree of separation. Sometimes the NHS pays for treatment in private facilities, and sometimes private insurance pays for treatment in NHS facilities.
DanBC 4y ago
We've had privatisation experiments in English healthcare for years. Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess. > It's run by Whitehall and politicians, with little input from those actually doing the real work. If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.
DanBC 4y ago
We've had privatisation experiments in English healthcare for years. Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess. > It's run by Whitehall and politicians, with little input from those actually doing the real work. If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work. > If there is to ever be any improvement in the NHS, there needs to be competition. What is "choose and book"? We tried competition, and it dramatically increased costs without doing anything at all to improve care. We're now spending considerable amounts of money rolling back some of that law.
- rleigh 4y ago
  Dentistry is a mess because of the funding model. It doesn't pay to be an NHS dentist, so most practices ceased to take NHS patients. If they fixed the funding model, the problem would resolve itself. The problem here was entirely self-inflicted by the NHS in its fixed price lists, which weren't sufficient to run a viable business on. The very opposite of a proper free-market economy. Finding an NHS dentist in some areas is impossible, but finding a private dentist is not. I've used both, and both were absolutely fine. The private dentist was more expensive, but they were charging a reasonable amount to fully cover their salaries, facilities and consumables. As with everything, you get what you pay for. Regarding competition, the NHS hasn't really tried competition seriously now, has it? Not really. Not actually doing a complete decoupling the insurance funding and the service provision. The "choose and book" isn't that, is it? It's a small attempt, which is better than nothing, but it's not really surprising that it didn't drive a huge amount of change, when it's not really going to have a big impact upon the bottom line.
- missedthecue 4y ago
  "Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess" A mess in what way? Do you have to wait 2 years for a private dentistry appointment? Because that's the current wait time for an NHS psychiatrist.
ljf 4y ago
An average of £2,647 per person.
deleted 4y ago
[deleted]

by rleigh 4y ago

gautamcgoel 4y ago

Isn't your argument really an argument against paying taxes in general?

rleigh 4y ago
It wasn't intended to be so, but overall I do think that taxes could be reduced significantly. I do think that taxes are used inefficiently and that individuals are better at making decisions in their own and local interests in place of poorly-accountable bureaucracies. But I certainly am not advocating for not paying taxes at all!

ricardobayes 4y ago

Even though I agree with your comment, I don't know of any European countries where you could opt-out from paying social security. Even if some small eastern european country has this option, it is probably unsustainable for a larger country (or one with more healthcare spending).

rleigh 4y ago
It could be done multiple ways. You could pay into a government insurance scheme or you could pay into a private one. The main point is that the payment of the insurance premiums is decoupled from the service provision. Right now the two are tightly-coupled and you can't realistically choose either of them. Look at the French model as an example. On a small scale, there is some degree of separation. Sometimes the NHS pays for treatment in private facilities, and sometimes private insurance pays for treatment in NHS facilities.

DanBC 4y ago

We've had privatisation experiments in English healthcare for years. Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess. Large private provision of GP care? They can't do it and they hand the contracts back. Specialist commissioning in mental health? It's a fucking mess. > It's run by Whitehall and politicians, with little input from those actually doing the real work. If you say things like this it makes me think that you don't know that NHSEngland/Improvement is an arms-length-body, nor what that means in terms of command and control of the English NHS. It makes me think that you didn't know what CCGs were nor how they worked, and that you don't know what an ICS/ICB is nor how they work.

DanBC 4y ago

rleigh 4y ago
Dentistry is a mess because of the funding model. It doesn't pay to be an NHS dentist, so most practices ceased to take NHS patients. If they fixed the funding model, the problem would resolve itself. The problem here was entirely self-inflicted by the NHS in its fixed price lists, which weren't sufficient to run a viable business on. The very opposite of a proper free-market economy. Finding an NHS dentist in some areas is impossible, but finding a private dentist is not. I've used both, and both were absolutely fine. The private dentist was more expensive, but they were charging a reasonable amount to fully cover their salaries, facilities and consumables. As with everything, you get what you pay for. Regarding competition, the NHS hasn't really tried competition seriously now, has it? Not really. Not actually doing a complete decoupling the insurance funding and the service provision. The "choose and book" isn't that, is it? It's a small attempt, which is better than nothing, but it's not really surprising that it didn't drive a huge amount of change, when it's not really going to have a big impact upon the bottom line.
missedthecue 4y ago
"Dentistry is a fucking mess. Eye care is a fucking mess. Care and Nursing homes are a fucking mess" A mess in what way? Do you have to wait 2 years for a private dentistry appointment? Because that's the current wait time for an NHS psychiatrist.

ljf 4y ago

An average of £2,647 per person.

deleted 4y ago

[deleted]