6 ms·

What if the government allowed private enterprise to open emergency clinics in times of great need? There are probably a lot of people who would be willing to p

What if the government allowed private enterprise to open emergency clinics in times of great need? There are probably a lot of people who would be willing to pay out of pocket for medical care, especially in an emergency, if it meant getting seen sooner.

Cthulhu_ 4y ago
Private enterprises are already running a significant chunk of UK health care at the moment; the Tory government is dismantling the socialized health care in favor of short-term profit. It's not about whether people are willing, it's whether they can afford it or if they have no choice but to go into debt. Anyway, the NHS has also paid private clinics already because their own facilities are at capacity.
- simonswords82 4y ago
  The nhs also has a shedload of funding. Let’s not overlook the aging population in the UK please. There are many more factors than simply “the Tories are to blame”
  - X0Refraction 4y ago
    This is the actual issue, spending isn't keeping up with the demand. I'd agree that "the Tories are to blame" doesn't capture it, but I don't think they're equipped to deal with the problem. Real terms spending per age adjusted capita appears to have been on a downwards trend [0] since they took power. I think this has gone up since the pandemic, but I think it's likely too little too late and will probably be a short term increase. I'm also skeptical the IFS have managed to accurately estimate the required increase in funding. They don't go into their workings from what I can see, but I doubt they've accurately included the effect of the lifetime allowance on pensions causing doctors to avoid overtime or the £100k tax bracket where you lose your personal allowance not moving since 2009 which more and more doctors will fall into. I'd imagine they've underestimated it, but would be happy to hear evidence to the contrary. That's not to say that I think any other party has a solution or is properly holding the Tories to account on this. I'll admit I haven't thought too hard about the problem, but I think the fairest solution would be to make pensioners pay national insurance on their income. It wouldn't affect the poorest pensioners and since national insurance is no longer ring fenced for pensions/healthcare I'm not sure what the justification for a tax break based on age even is anymore. As someone who intends to subsist on more in retirement that change would negatively affect me, but I still think it's fair. I know that this would be deeply unpopular though, so I don't hold out much hope of it happening anytime soon. Maybe that isn't the best solution, but I really wish we'd start to have real discourse on how we need to restructure our society as the demographic of the country continues to skew older. [0] https://ifs.org.uk/publications/9186 https://ifs.org.uk/publications/9186 (figure 5)
    - simonswords82 4y ago
      Interesting - nice to have a sensible debate on it. I think your idea is worth pursuing even if it's not perfect. Young people should not be subsidising old people who no longer work - especially those same young people who don't own house or have savings or a pension.
  - swores 4y ago
    It would get a lot more value from that funding if the Tories (and to be fair, also the last Labour gov a decade and a half ago, though not as much) hadn't been pushing so much of it towards embedding privatisation through the NHS such that profits are pointlessly being taken out at all stages. (Well, obviously not pointless for the shareholders, who happen to often coincidentally be tory party donors.) A hospital having a 20% bigger budget for their janitorial staff isn't in a better position if it's also been required to move from hiring full time cleaners in-house to contracting an approved cleaning company that has 30% profit margin baked in. An NHS patient isn't helped knowing that 50% more funding goes into paying consultants for the problem they have, if gradually more and more of those consultants are moving to private health companies and having to be rented back to the NHS at a markup that pays both the doctor and the company's shareholders. Etc etc. Sure, the population demographics are related, but even if we had the exact same population as 20 years ago we'd be in a much worse situation; plus it's the government's job to pay attention to things like demo changes in their population, and to listen to the warnings that have been coming from the medical community for many years, and should have been proactively funding better social care (instead of completely abandoning it to local councils while also lowering their funding) AND making the NHS even better (rather than gradually turning it into an umbrella for private companies who eat up any budget increases).
hotpotamus 4y ago
Yep, your money or your life is a strong economic incentive indeed.
SketchySeaBeast 4y ago
Emergency care specific private enterprise seems incredibly predatory. I also wonder where the infrastructure and staff for these surge clinics would come from.
bzxcvbn 4y ago
The USA have tried, it doesn't work. People still wait hours and hours in the ER. They just have to pay thousands for the privilege.
- skeeter2020 4y ago
  This isn't exactly true, nor what the GP is suggesting. Supplementing public service with private is already happening in the UK and very common around the world in even the most socialized, public systems like Canada. Where the US shines is high-end ongoing treatment, for which you do pay big bucks.
- 1234letshaveatw 4y ago
  doesn't work? there are urgent care places everywhere
  - bzxcvbn 4y ago
    Have you tried one? Last time my wife went in there for a broken back, she was told to sit in a chair at 10PM and to wait until 8AM for the doctor to come in.
  - SantalBlush 4y ago
    The last time I was in an urgent care facility, the doctor tried to upsell us on a medical procedure. When he left the room, the nurse assured us the procedure was unnecessary and he just wanted to charge us more. I wish I were making this up.
- jimbob45 4y ago
  People still wait hours and hours in the ER [in the US] If you have a genuine emergency, you'll be seen immediately virtually anywhere in the US.
Broken_Hippo 4y ago
Tell me, if you are having a heart attack or have had a stroke, how likely are you to have the mental fortitude required to realize that not only is there a for-profit emergency service, but you can pay to get seen now? Probably not very likely. If your emergency is urgent but not actually life threatening, then you might. You might - might - think of it if you have gall bladder or appendix types of pain, if you aren't in too much pain to think about it. And how, exactly, would this go into place? Would you call the emergency line, who proceeds to upsell you on a premium emergency room that will see you right now if only you pay money upfront? Does this also mean that poor people's lives are worth less since they cannot pay up? How about teenagers, who might be calling the emergency line yet don't actually have money to pay?
- brutusborn 4y ago
  Your strawmam is accurate, stroke survivors will need an ambulance. But you're forgetting that a lot of people get driven to emergency by friends or family. And if those bystanders pass a private hospital on the way to public emergency, they could decide their friend / family members life is worth the extra cost. Of course it wouldn't work for everyone, but it would ease the pressure on a failing system. Also your tone isn't conducive to a constructive discussion and is not appropriate when responding to someone who is suggesting ways to make the world a better place. Just because you can't imagine someone's idea working doesn't mean it's a bad one.
  - Broken_Hippo 4y ago
    I drove my father to the hospital when he was having a stroke. To be fair, I didn't know until he told the nurses. Just because someone is being driven by family doesn't mean that it isn't serious nor that there is realistically a chance to call around because of price. I don't care if you find my tone constructive, by the way. The issues I've raise are real issues, and if you can't explain how you'd get around these and still be sure to have the same quality of care for the poorest of people, it isn't a good plan. Unless, you know, the "separate but equal" (Which rarely works) is your goal.
    - 4y ago
neilwilson 4y ago
"What if the government allowed private enterprise to open emergency clinics in times of great need?" Using what for doctors? The problem is a supply side shortage of medical staff. Praying to the god of the private sector won't magically cause doctors to appear. I'll remind everybody again. Primary care in the UK has been in private hands since 1948. It's the lack of capacity in the private part of the NHS that is driving people towards A&E for basic stuff.
selfhoster11 4y ago
Hell no. NHS as a public service is currently fighting for its life. Opening up to private enterprise would accomplish the goal of killing and/or privatising it even quicker.

Cthulhu_ 4y ago

Private enterprises are already running a significant chunk of UK health care at the moment; the Tory government is dismantling the socialized health care in favor of short-term profit. It's not about whether people are willing, it's whether they can afford it or if they have no choice but to go into debt. Anyway, the NHS has also paid private clinics already because their own facilities are at capacity.

simonswords82 4y ago
The nhs also has a shedload of funding. Let’s not overlook the aging population in the UK please. There are many more factors than simply “the Tories are to blame”
- X0Refraction 4y ago
  This is the actual issue, spending isn't keeping up with the demand. I'd agree that "the Tories are to blame" doesn't capture it, but I don't think they're equipped to deal with the problem. Real terms spending per age adjusted capita appears to have been on a downwards trend [0] since they took power. I think this has gone up since the pandemic, but I think it's likely too little too late and will probably be a short term increase. I'm also skeptical the IFS have managed to accurately estimate the required increase in funding. They don't go into their workings from what I can see, but I doubt they've accurately included the effect of the lifetime allowance on pensions causing doctors to avoid overtime or the £100k tax bracket where you lose your personal allowance not moving since 2009 which more and more doctors will fall into. I'd imagine they've underestimated it, but would be happy to hear evidence to the contrary. That's not to say that I think any other party has a solution or is properly holding the Tories to account on this. I'll admit I haven't thought too hard about the problem, but I think the fairest solution would be to make pensioners pay national insurance on their income. It wouldn't affect the poorest pensioners and since national insurance is no longer ring fenced for pensions/healthcare I'm not sure what the justification for a tax break based on age even is anymore. As someone who intends to subsist on more in retirement that change would negatively affect me, but I still think it's fair. I know that this would be deeply unpopular though, so I don't hold out much hope of it happening anytime soon. Maybe that isn't the best solution, but I really wish we'd start to have real discourse on how we need to restructure our society as the demographic of the country continues to skew older. [0] https://ifs.org.uk/publications/9186 https://ifs.org.uk/publications/9186 (figure 5)
  - simonswords82 4y ago
    Interesting - nice to have a sensible debate on it. I think your idea is worth pursuing even if it's not perfect. Young people should not be subsidising old people who no longer work - especially those same young people who don't own house or have savings or a pension.
- swores 4y ago
  It would get a lot more value from that funding if the Tories (and to be fair, also the last Labour gov a decade and a half ago, though not as much) hadn't been pushing so much of it towards embedding privatisation through the NHS such that profits are pointlessly being taken out at all stages. (Well, obviously not pointless for the shareholders, who happen to often coincidentally be tory party donors.) A hospital having a 20% bigger budget for their janitorial staff isn't in a better position if it's also been required to move from hiring full time cleaners in-house to contracting an approved cleaning company that has 30% profit margin baked in. An NHS patient isn't helped knowing that 50% more funding goes into paying consultants for the problem they have, if gradually more and more of those consultants are moving to private health companies and having to be rented back to the NHS at a markup that pays both the doctor and the company's shareholders. Etc etc. Sure, the population demographics are related, but even if we had the exact same population as 20 years ago we'd be in a much worse situation; plus it's the government's job to pay attention to things like demo changes in their population, and to listen to the warnings that have been coming from the medical community for many years, and should have been proactively funding better social care (instead of completely abandoning it to local councils while also lowering their funding) AND making the NHS even better (rather than gradually turning it into an umbrella for private companies who eat up any budget increases).

hotpotamus 4y ago

Yep, your money or your life is a strong economic incentive indeed.

SketchySeaBeast 4y ago

Emergency care specific private enterprise seems incredibly predatory. I also wonder where the infrastructure and staff for these surge clinics would come from.

bzxcvbn 4y ago

The USA have tried, it doesn't work. People still wait hours and hours in the ER. They just have to pay thousands for the privilege.

skeeter2020 4y ago
This isn't exactly true, nor what the GP is suggesting. Supplementing public service with private is already happening in the UK and very common around the world in even the most socialized, public systems like Canada. Where the US shines is high-end ongoing treatment, for which you do pay big bucks.
1234letshaveatw 4y ago
doesn't work? there are urgent care places everywhere
- bzxcvbn 4y ago
  Have you tried one? Last time my wife went in there for a broken back, she was told to sit in a chair at 10PM and to wait until 8AM for the doctor to come in.
- SantalBlush 4y ago
  The last time I was in an urgent care facility, the doctor tried to upsell us on a medical procedure. When he left the room, the nurse assured us the procedure was unnecessary and he just wanted to charge us more. I wish I were making this up.
jimbob45 4y ago
People still wait hours and hours in the ER [in the US] If you have a genuine emergency, you'll be seen immediately virtually anywhere in the US.

Broken_Hippo 4y ago

Tell me, if you are having a heart attack or have had a stroke, how likely are you to have the mental fortitude required to realize that not only is there a for-profit emergency service, but you can pay to get seen now? Probably not very likely. If your emergency is urgent but not actually life threatening, then you might. You might - might - think of it if you have gall bladder or appendix types of pain, if you aren't in too much pain to think about it. And how, exactly, would this go into place? Would you call the emergency line, who proceeds to upsell you on a premium emergency room that will see you right now if only you pay money upfront? Does this also mean that poor people's lives are worth less since they cannot pay up? How about teenagers, who might be calling the emergency line yet don't actually have money to pay?

brutusborn 4y ago
Your strawmam is accurate, stroke survivors will need an ambulance. But you're forgetting that a lot of people get driven to emergency by friends or family. And if those bystanders pass a private hospital on the way to public emergency, they could decide their friend / family members life is worth the extra cost. Of course it wouldn't work for everyone, but it would ease the pressure on a failing system. Also your tone isn't conducive to a constructive discussion and is not appropriate when responding to someone who is suggesting ways to make the world a better place. Just because you can't imagine someone's idea working doesn't mean it's a bad one.
- Broken_Hippo 4y ago
  I drove my father to the hospital when he was having a stroke. To be fair, I didn't know until he told the nurses. Just because someone is being driven by family doesn't mean that it isn't serious nor that there is realistically a chance to call around because of price. I don't care if you find my tone constructive, by the way. The issues I've raise are real issues, and if you can't explain how you'd get around these and still be sure to have the same quality of care for the poorest of people, it isn't a good plan. Unless, you know, the "separate but equal" (Which rarely works) is your goal.
  - 4y ago

neilwilson 4y ago

"What if the government allowed private enterprise to open emergency clinics in times of great need?" Using what for doctors? The problem is a supply side shortage of medical staff. Praying to the god of the private sector won't magically cause doctors to appear. I'll remind everybody again. Primary care in the UK has been in private hands since 1948. It's the lack of capacity in the private part of the NHS that is driving people towards A&E for basic stuff.

selfhoster11 4y ago

Hell no. NHS as a public service is currently fighting for its life. Opening up to private enterprise would accomplish the goal of killing and/or privatising it even quicker.