5 ms·

It’s almost as if centralized control of resources doesn’t allocate them optimally.

owisd 4y ago
Seems to work better in this case, as essentially the only buyer of pharmaceuticals in the country the NHS are in a better position to negotiate deals in bulk than if hospitals had to negotiate individually. The UK has higher life expectancy than the USA for 2.5x less per capita healthcare spending.
oliwarner 4y ago
No, you've learned the wrong lesson. It's almost as if a locally allocated choice between collecting the bins and homing grandma will always go with what inconveniences voters least. Areas with poor, old populations can never pay their way. The excess gets dumped on the centrally funded NHS. It's a bad model that is a massive disservice to us all.
- lotsofpulp 4y ago
  >Areas with poor, old populations can never pay their way. The root of the issue is that this area is now the country. Giving all old people the labor necessary to support them in old age was easier when the ratio of working people to non working people was much higher, in conjunction with old people not living as long. Turn that population pyramid upside down due to drastically reduced birthrates and medical technology allowing people to live longer, and you get the current situation.
  - oliwarner 4y ago
    You say that like it's an imperative but it's not. This is a choice. Through the government we elected, we choose to starve social care. We choose to starve education and so many other public services. Yes, our age profile made it more expensive, but so what? We choose to underfund it.
    - mensetmanusman 4y ago
      If everyone is taking care of the elderly there is no one left to generate the wealth that props up society.
      - oliwarner 4y ago
        Community care is far cheaper for society than having families take on extra dependants, especially at the most taxable end of their lives. Its interactions with the economy are very much like childcare. But neither are happening. Old people are abandoned to healthcare providers. This, in turn impacts on the life expectancy of much younger people requiring emergency care who won't get it because the hospital and ambulances are full. It's not sustainable for patients or providers. There are two ways out. Choose to do this properly, or choose a much uglier withdrawal of care for the old and infirm. Before you choose, remember that these are people who worked for 45 years being told that their National Insurance payments were paying it forward for this kind of care. If you're going to change the rules —and especially if you're going to start incinerating grandmas when they get "too costly"— you have to expect the next generation probably isn't going to stick around. Many of that exodus will be doctors.
    - origin_path 4y ago
      It's actually through the local governments, many of which are Labour yet have the same issue. Root cause: the law says to raise local taxes beyond a certain amount councils must hold a referendum. They systematically refuse to do this because they know they will lose. Voters by and large think local councils are wasteful and don't really need more money. There's also another issue: some local councils especially in the North have a history of deliberately cutting front line services whilst e.g. expanding the central bureaucracy, because they know they can blame the Tories for not giving them "enough" money and the voters will fall for it. The councils could raise taxes, or rebalance spending, but that wouldn't energize their base.
      - oliwarner 4y ago
        Well I suggest you visit Norfolk. Councils have sold off their long-held land to developers, dumped their investments to their mates, stripped down services and tendered the rest. Serco does everything. Save the odd blip, Norfolk is as blue as it gets. Interestingly they also blame central government. And local tax raising is pretty blunt. How much your house would have been worth in April 1991, if you're working. High-retirement or high-unemployment areas usually have lower rates, and much lower incomes, while needing more than rich areas.

Seems to work better in this case, as essentially the only buyer of pharmaceuticals in the country the NHS are in a better position to negotiate deals in bulk than if hospitals had to negotiate individually. The UK has higher life expectancy than the USA for 2.5x less per capita healthcare spending.

oliwarner 4y ago

No, you've learned the wrong lesson. It's almost as if a locally allocated choice between collecting the bins and homing grandma will always go with what inconveniences voters least. Areas with poor, old populations can never pay their way. The excess gets dumped on the centrally funded NHS. It's a bad model that is a massive disservice to us all.

lotsofpulp 4y ago
>Areas with poor, old populations can never pay their way. The root of the issue is that this area is now the country. Giving all old people the labor necessary to support them in old age was easier when the ratio of working people to non working people was much higher, in conjunction with old people not living as long. Turn that population pyramid upside down due to drastically reduced birthrates and medical technology allowing people to live longer, and you get the current situation.
- oliwarner 4y ago
  You say that like it's an imperative but it's not. This is a choice. Through the government we elected, we choose to starve social care. We choose to starve education and so many other public services. Yes, our age profile made it more expensive, but so what? We choose to underfund it.
  - mensetmanusman 4y ago
    If everyone is taking care of the elderly there is no one left to generate the wealth that props up society.
    - oliwarner 4y ago
      Community care is far cheaper for society than having families take on extra dependants, especially at the most taxable end of their lives. Its interactions with the economy are very much like childcare. But neither are happening. Old people are abandoned to healthcare providers. This, in turn impacts on the life expectancy of much younger people requiring emergency care who won't get it because the hospital and ambulances are full. It's not sustainable for patients or providers. There are two ways out. Choose to do this properly, or choose a much uglier withdrawal of care for the old and infirm. Before you choose, remember that these are people who worked for 45 years being told that their National Insurance payments were paying it forward for this kind of care. If you're going to change the rules —and especially if you're going to start incinerating grandmas when they get "too costly"— you have to expect the next generation probably isn't going to stick around. Many of that exodus will be doctors.
  - origin_path 4y ago
    It's actually through the local governments, many of which are Labour yet have the same issue. Root cause: the law says to raise local taxes beyond a certain amount councils must hold a referendum. They systematically refuse to do this because they know they will lose. Voters by and large think local councils are wasteful and don't really need more money. There's also another issue: some local councils especially in the North have a history of deliberately cutting front line services whilst e.g. expanding the central bureaucracy, because they know they can blame the Tories for not giving them "enough" money and the voters will fall for it. The councils could raise taxes, or rebalance spending, but that wouldn't energize their base.
    - oliwarner 4y ago
      Well I suggest you visit Norfolk. Councils have sold off their long-held land to developers, dumped their investments to their mates, stripped down services and tendered the rest. Serco does everything. Save the odd blip, Norfolk is as blue as it gets. Interestingly they also blame central government. And local tax raising is pretty blunt. How much your house would have been worth in April 1991, if you're working. High-retirement or high-unemployment areas usually have lower rates, and much lower incomes, while needing more than rich areas.